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_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_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_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_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_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_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	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			
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	0.00	6.60	0.00	6.60			0.00	6.60			
H0028	001	0	1	01	01	H0028_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		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												
H0028	001	0	1	01	01	H0028_001_0	3	5	Specialty Tier	1	4	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												
H0028	001	0	1	01	01	H0028_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	001	0	1	01	01	H0028_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		30.00				0.33	10.00		0.00				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	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		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												
H0028	001	0	1	01	01	H0028_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		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										2	3	
H0028	001	0	1	01	01	H0028_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	001	0	1	01	01	H0028_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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H0028	001	0	1	01	01	H0028_001_0	3	5	Specialty Tier	3	4	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										2	3	
H0028	002	0	1	01	01	H0028_002_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0028	002	0	1	01	01	H0028_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	002	0	1	01	01	H0028_002_0	3	5	Specialty Tier	1	4	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												
H0028	002	0	1	01	01	H0028_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		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												
H0028	002	0	1	01	01	H0028_002_0	3	5	Specialty Tier	3	4	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										2	3	
H0028	002	0	1	01	01	H0028_002_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		30.00				0.33	10.00		0.00				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	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		15.00				0.16	5.00		0.00				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	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		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										2	3	
H0028	002	0	1	01	01	H0028_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		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										2	3	
H0028	002	0	1	01	01	H0028_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		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												
H0028	003	0	1	01	01	H0028_003_0	3	5	Specialty Tier	3	4	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										2	3	
H0028	003	0	1	01	01	H0028_003_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		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										2	3	
H0028	003	0	1	01	01	H0028_003_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		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										2	3	
H0028	003	0	1	01	01	H0028_003_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0028	003	0	1	01	01	H0028_003_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	003	0	1	01	01	H0028_003_0	3	5	Specialty Tier	1	4	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												
H0028	003	0	1	01	01	H0028_003_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		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												
H0028	003	0	1	01	01	H0028_003_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	003	0	1	01	01	H0028_003_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		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												
H0028	003	0	1	01	01	H0028_003_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	004	0	1	01	01	H0028_004_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H0028	004	0	1	01	01	H0028_004_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	004	0	1	01	01	H0028_004_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0028	004	0	1	01	01	H0028_004_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	004	0	1	01	01	H0028_004_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	004	0	1	01	01	H0028_004_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		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												
H0028	004	0	1	01	01	H0028_004_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		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										2	3	
H0028	004	0	1	01	01	H0028_004_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		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										2	3	
H0084	001	0	1	04	01	H0084_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																															135.00							125.00				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	4	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							8.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	001	0	1	04	01	H0084_001_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.40	12.00		36.00																															36.00							24.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	001	0	1	04	01	H0084_001_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					779.00	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	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							275.00				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	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							275.00				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	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							125.00				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	4	5	Specialty Tier	1	3	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												
H0084	004	0	1	04	01	H0084_004_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.40	12.00		36.00																															36.00							24.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	004	0	1	04	01	H0084_004_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															9.00							6.00				3.00				.09	3.00		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		12.00					.13	4.00		8.00					.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		36.00					.40	12.00		24.00					.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		135.00					1.50	45.00		90.00					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		225.00					2.50	75.00		150.00					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		12.00					.13	4.00		8.00					.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		36.00					.40	12.00		24.00					.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		135.00					1.50	45.00		90.00					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		225.00					2.50	75.00		150.00					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		36.00					.40	12.00		24.00					.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		12.00					.13	4.00		8.00					.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		135.00					1.50	45.00		90.00					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		225.00					2.50	75.00		150.00					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		12.00					.13	4.00		8.00					.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		36.00					.40	12.00		24.00					.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		135.00					1.50	45.00		90.00					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		225.00					2.50	75.00		150.00					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		12.00					.13	4.00		8.00					.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		36.00					.40	12.00		24.00					.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		225.00					2.50	75.00		150.00					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		135.00					1.50	45.00		90.00					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	10	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.40	12.00		36.00					.40	12.00		24.00					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	1	1	04	01	H0104_011_1	10	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		12.00					.13	4.00		8.00					.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	10	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		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	10	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	10	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.16	95.00		285.00					3.16	95.00		190.00					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	8	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.40	12.00		36.00					.40	12.00		24.00					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	2	1	04	01	H0104_011_2	8	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		12.00					.13	4.00		8.00					.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	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		90.00					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	8	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.16	95.00		285.00					3.16	95.00		190.00					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	8	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	8	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		12.00					.13	4.00		8.00					.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	8	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.40	12.00		36.00					.40	12.00		24.00					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	3	1	04	01	H0104_011_3	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		90.00					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	8	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.16	95.00		285.00					3.16	95.00		190.00					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	8	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	8	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.40	12.00		36.00					.40	12.00		24.00					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	4	1	04	01	H0104_011_4	8	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		12.00					.13	4.00		8.00					.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	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		90.00					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	8	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	8	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.16	95.00		285.00					3.16	95.00		190.00					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	8	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		12.00					.13	4.00		8.00					.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	8	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.40	12.00		36.00					.40	12.00		24.00					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	5	1	04	01	H0104_011_5	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		90.00					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	8	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.16	95.00		285.00					3.16	95.00		190.00					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	8	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	8	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		12.00					.13	4.00		8.00					.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	8	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.40	12.00		36.00					.40	12.00		24.00					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	6	1	04	01	H0104_011_6	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		90.00					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	8	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.16	95.00		285.00					3.16	95.00		190.00					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	8	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	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	8	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	8	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	8	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	9	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H0108	004	0	1	01	01	H0108_004_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		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												
H0108	004	0	1	01	01	H0108_004_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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H0108	004	0	1	01	01	H0108_004_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	004	0	1	01	01	H0108_004_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	004	0	1	01	01	H0108_004_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		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										2	3	
H0108	004	0	1	01	01	H0108_004_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	005	0	1	01	01	H0108_005_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		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												
H0108	005	0	1	01	01	H0108_005_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		
H0108	005	0	1	01	01	H0108_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		30.00				0.33	10.00		0.00				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	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		90.00				1.00	30.00		60.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	005	0	1	01	01	H0108_005_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		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										2	3	
H0108	005	0	1	01	01	H0108_005_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H0108	005	0	1	01	01	H0108_005_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												
H0108	005	0	1	01	01	H0108_005_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		90.00				1.00	30.00		60.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	005	0	1	01	01	H0108_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	006	0	1	01	01	H0108_006_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H0108	006	0	1	01	01	H0108_006_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		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										2	3	
H0108	006	0	1	01	01	H0108_006_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		90.00				1.00	30.00		60.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	006	0	1	01	01	H0108_006_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.06	2.00		6.00																												0.06	2.00		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										1		
H0108	006	0	1	01	01	H0108_006_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		
H0108	006	0	1	01	01	H0108_006_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		90.00				1.00	30.00		60.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	006	0	1	01	01	H0108_006_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		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												
H0108	006	0	1	01	01	H0108_006_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.06	2.00		6.00																												0.06	2.00		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												
H0108	006	0	1	01	01	H0108_006_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												
H0108	008	0	1	01	01	H0108_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		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												
H0108	008	0	1	01	01	H0108_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	008	0	1	01	01	H0108_008_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	008	0	1	01	01	H0108_008_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	008	0	1	01	01	H0108_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		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										2	3	
H0108	008	0	1	01	01	H0108_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	008	0	1	01	01	H0108_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		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												
H0108	008	0	1	01	01	H0108_008_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H0108	009	0	1	01	01	H0108_009_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												
H0108	009	0	1	01	01	H0108_009_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	009	0	1	01	01	H0108_009_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		90.00				1.00	30.00		60.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	009	0	1	01	01	H0108_009_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		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												
H0108	009	0	1	01	01	H0108_009_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	009	0	1	01	01	H0108_009_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		
H0108	009	0	1	01	01	H0108_009_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	009	0	1	01	01	H0108_009_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		90.00				1.00	30.00		60.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	009	0	1	01	01	H0108_009_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		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										2	3	
H0108	009	0	1	01	01	H0108_009_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H0108	010	0	1	01	01	H0108_010_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												
H0108	010	0	1	01	01	H0108_010_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		30.00				0.33	10.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H0108	010	0	1	01	01	H0108_010_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		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										2	3	
H0108	010	0	1	01	01	H0108_010_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		30.00				0.33	10.00		0.00				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	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		
H0108	010	0	1	01	01	H0108_010_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H0108	010	0	1	01	01	H0108_010_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		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												
H0108	011	0	1	01	01	H0108_011_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												
H0108	011	0	1	01	01	H0108_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		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										2	3	
H0108	011	0	1	01	01	H0108_011_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		90.00				1.00	30.00		60.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	011	0	1	01	01	H0108_011_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	011	0	1	01	01	H0108_011_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H0108	011	0	1	01	01	H0108_011_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H0108	011	0	1	01	01	H0108_011_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		90.00				1.00	30.00		60.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	011	0	1	01	01	H0108_011_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	011	0	1	01	01	H0108_011_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		
H0108	021	0	1	01	01	H0108_021_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												
H0108	021	0	1	01	01	H0108_021_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		30.00				0.33	10.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H0108	021	0	1	01	01	H0108_021_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		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										2	3	
H0108	021	0	1	01	01	H0108_021_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		30.00				0.33	10.00		0.00				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	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		
H0108	021	0	1	01	01	H0108_021_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H0108	021	0	1	01	01	H0108_021_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		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												
H0108	022	0	1	01	01	H0108_022_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		15.00				0.16	5.00		0.00				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	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		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										2	3	
H0108	022	0	1	01	01	H0108_022_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		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										2	3	
H0108	022	0	1	01	01	H0108_022_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	022	0	1	01	01	H0108_022_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	022	0	1	01	01	H0108_022_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H0108	022	0	1	01	01	H0108_022_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		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												
H0108	022	0	1	01	01	H0108_022_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	022	0	1	01	01	H0108_022_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	023	0	1	01	01	H0108_023_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		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										2	3	
H0108	023	0	1	01	01	H0108_023_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H0108	023	0	1	01	01	H0108_023_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		30.00				0.33	10.00		0.00				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	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		
H0108	023	0	1	01	01	H0108_023_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H0108	023	0	1	01	01	H0108_023_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		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												
H0108	023	0	1	01	01	H0108_023_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		30.00				0.33	10.00		0.00				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	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												
H0108	024	0	1	01	01	H0108_024_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		15.00				0.16	5.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	024	0	1	01	01	H0108_024_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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H0108	024	0	1	01	01	H0108_024_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		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										2	3	
H0108	024	0	1	01	01	H0108_024_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	024	0	1	01	01	H0108_024_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		30.00				0.33	10.00		0.00				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	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		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												
H0108	024	0	1	01	01	H0108_024_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		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												
H0108	025	0	1	01	01	H0108_025_0	3	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		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												
H0108	025	0	1	01	01	H0108_025_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		30.00				0.33	10.00		0.00				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	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		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												
H0108	025	0	1	01	01	H0108_025_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		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												
H0108	025	0	1	01	01	H0108_025_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H0108	025	0	1	01	01	H0108_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		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										2	3	
H0108	025	0	1	01	01	H0108_025_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		30.00				0.33	10.00		0.00				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	3	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		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		
H0108	025	0	1	01	01	H0108_025_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				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	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		30.00				0.33	10.00		0.00				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	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		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												
H0108	026	0	1	01	01	H0108_026_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		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												
H0108	026	0	1	01	01	H0108_026_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	026	0	1	01	01	H0108_026_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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H0108	026	0	1	01	01	H0108_026_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		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										2	3	
H0108	026	0	1	01	01	H0108_026_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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												
H0108	027	0	1	01	01	H0108_027_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		30.00				0.33	10.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H0108	027	0	1	01	01	H0108_027_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		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										2	3	
H0108	027	0	1	01	01	H0108_027_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		30.00				0.33	10.00		0.00				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	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		
H0108	027	0	1	01	01	H0108_027_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H0108	027	0	1	01	01	H0108_027_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		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												
H0108	028	0	1	01	01	H0108_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		15.00				0.16	5.00		0.00				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	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		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										2	3	
H0108	028	0	1	01	01	H0108_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		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										2	3	
H0108	028	0	1	01	01	H0108_028_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		30.00				0.33	10.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	028	0	1	01	01	H0108_028_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		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												
H0108	028	0	1	01	01	H0108_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		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												
H0108	028	0	1	01	01	H0108_028_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		30.00				0.33	10.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	034	0	1	01	01	H0108_034_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												
H0108	034	0	1	01	01	H0108_034_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		30.00				0.33	10.00		0.00				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	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		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												
H0108	034	0	1	01	01	H0108_034_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		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												
H0108	034	0	1	01	01	H0108_034_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H0108	034	0	1	01	01	H0108_034_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		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										2	3	
H0108	034	0	1	01	01	H0108_034_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		30.00				0.33	10.00		0.00				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	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		
H0108	034	0	1	01	01	H0108_034_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H0108	035	0	1	01	01	H0108_035_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	
H0108	035	0	1	01	01	H0108_035_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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H0108	035	0	1	01	01	H0108_035_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H0108	035	0	1	01	01	H0108_035_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		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												
H0108	035	0	1	01	01	H0108_035_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		30.00				0.33	10.00		0.00				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	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												
H0108	037	0	1	01	01	H0108_037_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	037	0	1	01	01	H0108_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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H0108	037	0	1	01	01	H0108_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		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										2	3	
H0108	037	0	1	01	01	H0108_037_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	037	0	1	01	01	H0108_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		30.00				0.33	10.00		0.00				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	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		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												
H0108	037	0	1	01	01	H0108_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		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												
H0108	037	0	1	01	01	H0108_037_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H0108	038	0	1	01	01	H0108_038_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		15.00				0.16	5.00		0.00				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	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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H0108	038	0	1	01	01	H0108_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		30.00				0.33	10.00		0.00				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	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		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												
H0108	038	0	1	01	01	H0108_038_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		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												
H0108	038	0	1	01	01	H0108_038_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	039	0	1	01	01	H0108_039_0	3	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		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												
H0108	039	0	1	01	01	H0108_039_0	3	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		30.00				0.33	10.00		0.00				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	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		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												
H0108	039	0	1	01	01	H0108_039_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		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												
H0108	039	0	1	01	01	H0108_039_0	3	5	Specialty Tier	1	3	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												
H0108	041	0	1	01	01	H0108_041_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	041	0	1	01	01	H0108_041_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		30.00				0.33	10.00		0.00				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	4	5	Specialty Tier	1	3	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												
H0108	041	0	1	01	01	H0108_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		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												
H0108	041	0	1	01	01	H0108_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		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												
H0108	045	0	1	01	01	H0108_045_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		15.00				0.16	5.00		0.00				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	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		30.00				0.33	10.00		0.00				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	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		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												
H0108	045	0	1	01	01	H0108_045_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		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												
H0108	045	0	1	01	01	H0108_045_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	045	0	1	01	01	H0108_045_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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H0108	045	0	1	01	01	H0108_045_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		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										2	3	
H0108	045	0	1	01	01	H0108_045_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				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	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		30.00				0.33	10.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H0108	046	0	1	01	01	H0108_046_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		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										2	3	
H0108	046	0	1	01	01	H0108_046_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		30.00				0.33	10.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	046	0	1	01	01	H0108_046_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H0108	046	0	1	01	01	H0108_046_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		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												
H0108	047	0	1	01	01	H0108_047_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.06	2.00		6.00																												0.06	2.00		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												
H0108	047	0	1	01	01	H0108_047_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.06	2.00		6.00																												0.06	2.00		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										1		
H0108	047	0	1	01	01	H0108_047_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												
H0108	047	0	1	01	01	H0108_047_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		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										2	3	
H0108	047	0	1	01	01	H0108_047_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H0108	047	0	1	01	01	H0108_047_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		90.00				1.00	30.00		60.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	047	0	1	01	01	H0108_047_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		90.00				1.00	30.00		60.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	047	0	1	01	01	H0108_047_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		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												
H0108	047	0	1	01	01	H0108_047_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	047	0	1	01	01	H0108_047_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		
H0108	048	0	1	01	01	H0108_048_0	3	2	Non-Preferred Generic	1	3	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	048	0	1	01	01	H0108_048_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		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												
H0108	048	0	1	01	01	H0108_048_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		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												
H0108	048	0	1	01	01	H0108_048_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												
H0108	048	0	1	01	01	H0108_048_0	3	5	Specialty Tier	1	3	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												
H0108	050	0	1	01	01	H0108_050_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												
H0108	050	0	1	01	01	H0108_050_0	3	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.06	2.00		6.00																												0.06	2.00		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												
H0108	050	0	1	01	01	H0108_050_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		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												
H0108	050	0	1	01	01	H0108_050_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		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												
H0108	050	0	1	01	01	H0108_050_0	3	5	Specialty Tier	1	3	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												
H0108	054	0	1	01	01	H0108_054_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		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										2	3	
H0108	054	0	1	01	01	H0108_054_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	054	0	1	01	01	H0108_054_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		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												
H0108	054	0	1	01	01	H0108_054_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	054	0	1	01	01	H0108_054_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	054	0	1	01	01	H0108_054_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		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										2	3	
H0108	054	0	1	01	01	H0108_054_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	054	0	1	01	01	H0108_054_0	3	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		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		
H0108	054	0	1	01	01	H0108_054_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		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												
H0108	054	0	1	01	01	H0108_054_0	3	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		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												
H0108	055	0	1	01	01	H0108_055_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	055	0	1	01	01	H0108_055_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		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										2	3	
H0108	055	0	1	01	01	H0108_055_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		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										2	3	
H0108	055	0	1	01	01	H0108_055_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	055	0	1	01	01	H0108_055_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	055	0	1	01	01	H0108_055_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	055	0	1	01	01	H0108_055_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		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												
H0108	055	0	1	01	01	H0108_055_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		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												
H0108	055	0	1	01	01	H0108_055_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	055	0	1	01	01	H0108_055_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	056	0	1	01	01	H0108_056_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	056	0	1	01	01	H0108_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		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										2	3	
H0108	056	0	1	01	01	H0108_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	056	0	1	01	01	H0108_056_0	3	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		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		
H0108	056	0	1	01	01	H0108_056_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		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										2	3	
H0108	056	0	1	01	01	H0108_056_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		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												
H0108	056	0	1	01	01	H0108_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		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												
H0108	056	0	1	01	01	H0108_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	056	0	1	01	01	H0108_056_0	3	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		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												
H0108	056	0	1	01	01	H0108_056_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	057	0	1	01	01	H0108_057_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		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										2	3	
H0108	057	0	1	01	01	H0108_057_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	057	0	1	01	01	H0108_057_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	057	0	1	01	01	H0108_057_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	057	0	1	01	01	H0108_057_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		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												
H0108	057	0	1	01	01	H0108_057_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		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												
H0108	057	0	1	01	01	H0108_057_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	057	0	1	01	01	H0108_057_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	057	0	1	01	01	H0108_057_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	057	0	1	01	01	H0108_057_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		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										2	3	
H0108	058	0	1	01	01	H0108_058_0	3	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		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												
H0108	058	0	1	01	01	H0108_058_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	058	0	1	01	01	H0108_058_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		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												
H0108	058	0	1	01	01	H0108_058_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		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												
H0108	058	0	1	01	01	H0108_058_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	058	0	1	01	01	H0108_058_0	3	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		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		
H0108	058	0	1	01	01	H0108_058_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	058	0	1	01	01	H0108_058_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		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										2	3	
H0108	058	0	1	01	01	H0108_058_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		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										2	3	
H0108	058	0	1	01	01	H0108_058_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	059	0	1	01	01	H0108_059_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	059	0	1	01	01	H0108_059_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		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												
H0108	059	0	1	01	01	H0108_059_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		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												
H0108	059	0	1	01	01	H0108_059_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	059	0	1	01	01	H0108_059_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	059	0	1	01	01	H0108_059_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	059	0	1	01	01	H0108_059_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		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										2	3	
H0108	059	0	1	01	01	H0108_059_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		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										2	3	
H0108	059	0	1	01	01	H0108_059_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	059	0	1	01	01	H0108_059_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0137	001	0	1	48	05	H0137_001_0	4	1	Generic Drugs	1	4	010000			111		10	111		1	31	60	90				2	31	60	90					10	31																																																					Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC 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	4	4	Non-Medicare Rx/OTC Drugs	1	4	010010			111		10	111		1	31	60	90				2	31	60	90					10	31																																																					Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC 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	4	3	Non-Preferred Brand Drugs	1	4	100000			111		10	111		1	31	60	90				2	31	60	90					10	31																																																					Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC 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	4	2	Preferred Brand Drugs	1	4	000001			111		10	111		1	31	60	90				2	31	60	90					10	31																																																					Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0141	004	1	1	01	01	H0141_004_1	8	1	Generic	1	4	010000	1	2	111		01			1	30	60	90				2							30		31	.16	5.00	10.00	11.25																																										5.00				.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	1	1	01	01	H0141_004_1	8	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	2.83	85.00	170.00	191.25																								191.25																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	1	1	01	01	H0141_004_1	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					599.42	29																							29																			29				29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	1	1	01	01	H0141_004_1	8	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				2			90				30		31	1.16	35.00	70.00	78.75																								78.75																		35.00				1.13	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	2	1	01	01	H0141_004_2	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					599.42	29																							29																			29				29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	2	1	01	01	H0141_004_2	9	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	2.83	85.00	170.00	191.25																								191.25																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	2	1	01	01	H0141_004_2	9	1	Generic	1	4	010000	1	2	111		01			1	30	60	90				2							30		31	.16	5.00	10.00	11.25																																										5.00				.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	2	1	01	01	H0141_004_2	9	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				2			90				30		31	1.16	35.00	70.00	78.75																								78.75																		35.00				1.13	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	1	1	01	01	H0141_005_1	9	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				2			90				30		31	1.16	35.00	70.00	78.75																								78.75																		35.00				1.13	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	1	1	01	01	H0141_005_1	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					597.98	29																							29																			29				29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	1	1	01	01	H0141_005_1	9	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	2.83	85.00	170.00	191.25																								191.25																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	1	1	01	01	H0141_005_1	9	1	Generic	1	4	010000	1	2	111		01			1	30	60	90				2							30		31	.16	5.00	10.00	11.25																																										5.00				.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	3	1	01	01	H0141_005_3	9	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	2.83	85.00	170.00	191.25																								191.25																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	3	1	01	01	H0141_005_3	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					597.98	29																							29																			29				29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	3	1	01	01	H0141_005_3	9	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				2			90				30		31	1.16	35.00	70.00	78.75																								78.75																		35.00				1.13	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	3	1	01	01	H0141_005_3	9	1	Generic	1	4	010000	1	2	111		01			1	30	60	90				2							30		31	.16	5.00	10.00	11.25																																										5.00				.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0147	001	0	1	48	05	H0147_001_0	4	2	Brand Drugs	1	4	010010			111		10	111		1	31	62	93				1	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	6.60			0.00	6.60	0.00	6.60			
H0147	001	0	1	48	05	H0147_001_0	4	1	Generic Drugs	1	4	010010			111		10	111		1	31	62	93				1	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	6.60			0.00	6.60	0.00	6.60			
H0147	001	0	1	48	05	H0147_001_0	4	3	Non-Medicare Rx Drugs	1	4	010000			010		10			1	31														10	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			
H0147	001	0	1	48	05	H0147_001_0	4	4	Non-Medicare OTC Drugs	1	4	010000			010		10			1	31														10	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			
H0148	001	0	1	48	05	H0148_001_0	2	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	2	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	0.00	2.65					0.00	2.65			
H0148	001	0	1	48	05	H0148_001_0	2	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	0.00	6.60					0.00	6.60			
H0148	002	0	1	48	05	H0148_002_0	3	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	002	0	1	48	05	H0148_002_0	3	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	0.00	6.60					0.00	6.60			
H0148	002	0	1	48	05	H0148_002_0	3	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	0.00	2.65					0.00	2.65			
H0150	024	1	1	01	01	H0150_024_1	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		9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	1	1	01	01	H0150_024_1	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		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	1	1	01	01	H0150_024_1	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	1	1	01	01	H0150_024_1	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		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0150	024	1	1	01	01	H0150_024_1	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		9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0150	024	1	1	01	01	H0150_024_1	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					667.44	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	1	1	01	01	H0150_024_1	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		255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	2	1	01	01	H0150_024_2	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		255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	2	1	01	01	H0150_024_2	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	2	1	01	01	H0150_024_2	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		9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0150	024	2	1	01	01	H0150_024_2	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					667.44	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	2	1	01	01	H0150_024_2	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		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	2	1	01	01	H0150_024_2	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		9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	2	1	01	01	H0150_024_2	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		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0151	001	0	1	01	01	H0151_001_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	001	0	1	01	01	H0151_001_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	001	0	1	01	01	H0151_001_0	2	5	Specialty Tier	1	3	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												
H0151	001	0	1	01	01	H0151_001_0	2	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							275.00				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	2	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							125.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					709.00	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	2	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							275.00				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	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	025	0	1	01	01	H0151_025_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	025	0	1	01	01	H0151_025_0	2	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							125.00				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	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									.66	20.00		60.00					.66	20.00		60.00															60.00							50.00				20.00				.64	20.00		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															135.00							112.50				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	100100	1	2		110	01		100	1				30		90	1						90	30		31									3.16	95.00		285.00					3.16	95.00		285.00															285.00							237.50				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									.13	4.00		12.00					0.00	0.00		0.00															12.00							0.00				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	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					3.16	95.00		285.00															285.00							237.50				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	5	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					0.00	0.00		0.00															12.00							0.00				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	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															45.00							37.50				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	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															135.00							112.50				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	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												
H0154	011	0	1	01	01	H0154_011_0	5	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					0.00	0.00		0.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0154	014	0	1	01	01	H0154_014_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					3.16	95.00		285.00															285.00							237.50				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	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												
H0154	014	0	1	01	01	H0154_014_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					0.00	0.00		0.00															12.00							0.00				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	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					.50	15.00		45.00															45.00							37.50				15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_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					1.50	45.00		135.00															135.00							112.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0192	001	0	1	48	05	H0192_001_0	7	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				1			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			
H0192	001	0	1	48	05	H0192_001_0	7	3	Non-Medicare Rx/OTC Drugs	1	4	000010			110		01	100		1	30		90				1			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			
H0192	001	0	1	48	05	H0192_001_0	7	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				1			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	3	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	3	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	6.60	0.00	6.60			0.00	6.60			
H0281	001	0	1	48	05	H0281_001_0	3	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			
H0294	002	0	1	04	01	H0294_002_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							125.00				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	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.43	13.00		39.00																															39.00							26.00				13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															9.00							6.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_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							275.00				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	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					391.00	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	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															15.00							10.00				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	3	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.43	13.00		39.00																															39.00							26.00				13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	3	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							125.00				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	3	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							275.00				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	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					396.00	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	15	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.29	9.00	18.00	27.00																								27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	15	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												
H0302	001	0	1	01	01	H0302_001_0	15	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.33	40.00	80.00	120.00																								120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	15	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																								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	15	5	Specialty Tier	1	4	101101	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	15	2	Non-Preferred Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.29	9.00	18.00	27.00																								27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	006	0	1	01	01	H0302_006_0	12	2	Non-Preferred Generic	1	4	000100	1	2	111		01	101		1	30	60	90				1		60	90				30		31	.30	9.00	18.00	27.00																							18.00	27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	12	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												
H0302	006	0	1	01	01	H0302_006_0	12	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																								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	12	2	Non-Preferred Generic	3	4	000100	1	2	111		01	101		1	30	60	90				1		60	90				30		31	.30	9.00	18.00	27.00																							18.00	27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	006	0	1	01	01	H0302_006_0	12	5	Specialty Tier	1	4	101101	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	12	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	007	0	1	01	01	H0302_007_0	10	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												
H0302	007	0	1	01	01	H0302_007_0	10	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.29	9.00	18.00	27.00																								27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	007	0	1	01	01	H0302_007_0	10	5	Specialty Tier	1	4	101101	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	007	0	1	01	01	H0302_007_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	2.66	80.00	160.00	240.00																								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	10	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.00	30.00	60.00	90.00																								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	10	2	Non-Preferred Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.29	9.00	18.00	27.00																								27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	008	0	1	01	01	H0302_008_0	9	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												
H0302	008	0	1	01	01	H0302_008_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.29	9.00	18.00	27.00																								27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	9	2	Non-Preferred Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.29	9.00	18.00	27.00																								27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	008	0	1	01	01	H0302_008_0	9	5	Specialty Tier	1	4	101101	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	008	0	1	01	01	H0302_008_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	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												
H0302	008	0	1	01	01	H0302_008_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																								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	3	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																															27.00							18.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0303	013	0	1	01	01	H0303_013_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0303	013	0	1	01	01	H0303_013_0	3	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							125.00				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	3	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0303	013	0	1	01	01	H0303_013_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					635.00	33		33																														33							33			33				33	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	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															24.00							16.00				8.00				0.25	8.00		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	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		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	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					657.00	33		33																														33							33			33				33	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	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															285.00							275.00				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	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							275.00				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	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							125.00				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	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		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	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															24.00							16.00				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	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					690.00	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	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					752.00	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	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		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	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															24.00							16.00				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	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															285.00							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0318	007	0	1	01	01	H0318_007_0	7	1	Preferred Generic	1	4	001000	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												
H0318	007	0	1	01	01	H0318_007_0	7	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					53.17	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0318	007	0	1	01	01	H0318_007_0	7	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0318	007	0	1	01	01	H0318_007_0	7	2	Non-Preferred Generic	1	4	000100	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	9.00																			3.00			.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0332	002	0	1	01	01	H0332_002_0	5	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		90	1							30		31									0.27	8.00		24.00					0.10	3.00		7.50																										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	5	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		90	1							30		31									1.10	33.00		99.00					1.00	30.00		75.00																										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	5	3	Preferred Brand	1	4	000001	1	2		110	01			1				30		90	1							30		31									1.50	45.00		135.00					1.33	40.00		100.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01			1				30		90	1							30		31									2.33	70.00		210.00					2.00	60.00		150.00																										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	5	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	5	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		90	1							30		31									0.27	8.00		24.00					0.10	3.00		7.50																										8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0332	004	0	1	02	01	H0332_004_0	7	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		90	1							30		31									0.27	8.00		24.00					0.10	3.00		7.50																										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	7	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		90	1							30		31									0.27	8.00		24.00					0.10	3.00		7.50																										8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0332	004	0	1	02	01	H0332_004_0	7	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	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01			1				30		90	1							30		31									2.33	70.00		210.00					2.00	60.00		150.00																										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	7	3	Preferred Brand	1	4	000001	1	2		110	01			1				30		90	1							30		31									1.50	45.00		135.00					1.33	40.00		100.00																										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	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		90	1							30		31									1.10	33.00		99.00					1.00	30.00		75.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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									1.00	30.00		90.00					0.67	20.00		60.00																										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	3	Preferred Brand	1	4	000001	1	2		110	01			1				30		90	1							30		31									1.00	30.00		90.00					0.67	20.00		60.00																										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	4	Non-Preferred Brand	1	4	100000	1	2		110	01			1				30		90	1							30		31									2.00	60.00		180.00					1.67	50.00		150.00																										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	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	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		90	1							30		31									0.33	10.00		30.00					0.00	0.00		0.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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									0.33	10.00		30.00					0.00	0.00		0.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0336	001	0	1	48	05	H0336_001_0	7	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	7	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	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	7	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	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	7	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			
H0351	029	0	1	01	01	H0351_029_0	6	5	Specialty Tier	1	3	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34						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	4	Non-Preferred Brand	1	3	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	275.00				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	3	Preferred Brand	1	3	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	125.00				45.00				1.32	45.00		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	3	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.67	20.00	40.00	60.00																												.67	20.00	40.00	60.00				.67	20.00	40.00	57.00				20.00				.58	20.00		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	3	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	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												
H0351	035	0	1	01	01	H0351_035_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	035	0	1	01	01	H0351_035_0	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.67	20.00	40.00	60.00					.50	15.00	30.00	45.00												0.67	20.00	40.00	60.00				0.50	15.00	30.00	42.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	035	0	1	01	01	H0351_035_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00												0.17	5.00	10.00	15.00				0.00	0.00	0.00	0.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	035	0	1	01	01	H0351_035_0	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	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	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00												0.17	5.00	10.00	15.00				0.00	0.00	0.00	0.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.50	15.00	30.00	45.00												0.67	20.00	40.00	60.00				0.50	15.00	30.00	42.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	4	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.47	44.00	88.00	132.00					1.13	34.00	68.00	102.00												1.47	44.00	88.00	132.00				1.13	34.00	68.00	92.00				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	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	4	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	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	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	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												
H0351	040	0	1	01	01	H0351_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	45.00				0.50	15.00	30.00	42.00				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	3	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.47	44.00	88.00	132.00																												1.47	44.00	88.00	132.00				1.47	44.00	88.00	122.00				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	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	275.00				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	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				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, Select Care Drugs												
H0351	040	0	1	01	01	H0351_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												
H0351	041	0	1	01	01	H0351_041_0	3	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.47	44.00	88.00	132.00																												1.47	44.00	88.00	132.00				1.47	44.00	88.00	122.00				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	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	275.00				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	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				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, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_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												
H0351	041	0	1	01	01	H0351_041_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												
H0351	041	0	1	01	01	H0351_041_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.40	12.00	24.00	36.00																												0.40	12.00	24.00	36.00				0.40	12.00	24.00	33.00				12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.50	15.00	30.00	45.00												0.67	20.00	40.00	60.00				0.50	15.00	30.00	42.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00												0.17	5.00	10.00	15.00				0.00	0.00	0.00	0.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	4	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.47	44.00	88.00	132.00					1.13	34.00	68.00	102.00												1.47	44.00	88.00	132.00				1.13	34.00	68.00	92.00				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	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	4	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	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	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	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.50	15.00	30.00	45.00												0.67	20.00	40.00	60.00				0.50	15.00	30.00	42.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	4	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					.07	2.00	4.00	6.00												0.23	7.00	14.00	21.00				0.07	2.00	3.00	3.00				7.00				0.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	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	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	4	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	4	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					.07	2.00	4.00	6.00												0.23	7.00	14.00	21.00				0.07	2.00	3.00	3.00				7.00				0.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.50	15.00	30.00	45.00												0.67	20.00	40.00	60.00				0.50	15.00	30.00	42.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	4	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	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	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	3	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												
H0354	001	0	1	01	01	H0354_001_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.33	10.00	20.00	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												
H0354	001	0	1	01	01	H0354_001_0	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.33	10.00	20.00	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										1		
H0354	001	0	1	01	01	H0354_001_0	3	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		
H0354	001	0	1	01	01	H0354_001_0	3	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					543.08	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	3	4	Non-Preferred Brand	1	4	100000	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	001	0	1	01	01	H0354_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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	021	0	1	01	01	H0354_021_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												
H0354	021	0	1	01	01	H0354_021_0	4	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		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	021	0	1	01	01	H0354_021_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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	021	0	1	01	01	H0354_021_0	4	4	Non-Preferred Brand	1	4	100000	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	021	0	1	01	01	H0354_021_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					473.14	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	021	0	1	01	01	H0354_021_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		
H0354	021	0	1	01	01	H0354_021_0	4	2	Non-Preferred Generic	3	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		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0354	023	0	1	01	01	H0354_023_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												
H0354	023	0	1	01	01	H0354_023_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		
H0354	023	0	1	01	01	H0354_023_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					534.85	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	023	0	1	01	01	H0354_023_0	4	4	Non-Preferred Brand	1	4	100000	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	023	0	1	01	01	H0354_023_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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	023	0	1	01	01	H0354_023_0	4	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		15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	023	0	1	01	01	H0354_023_0	4	2	Non-Preferred Generic	3	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		15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0408	003	0	1	01	01	H0408_003_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0408	003	0	1	01	01	H0408_003_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0408	003	0	1	01	01	H0408_003_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0408	003	0	1	01	01	H0408_003_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0408	003	0	1	01	01	H0408_003_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					651.00	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	10	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.55	17.00	29.00	35.00					0.39	12.00	24.00	30.00					0.40	12.00	24.00	30.00																		12.00				0.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	002	0	1	01	01	H0435_002_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.29	9.00	13.00	15.00					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, Non-Preferred Brand, Specialty Tier												
H0435	002	0	1	01	01	H0435_002_0	10	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.45	45.00	90.00	112.50					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, Non-Preferred Brand, Specialty Tier												
H0435	002	0	1	01	01	H0435_002_0	10	5	Specialty Tier	1	4	100000	1	1		010	01	010		1				30				30						30		31														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	10	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.06	95.00	185.00	275.00					2.90	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												
H0435	003	0	1	01	01	H0435_003_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.29	9.00	13.00	15.00					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, Non-Preferred Brand, Specialty Tier												
H0435	003	0	1	01	01	H0435_003_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.55	17.00	29.00	35.00					0.39	12.00	24.00	30.00					0.39	12.00	24.00	30.00																		12.00				0.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	003	0	1	01	01	H0435_003_0	8	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.06	95.00	185.00	275.00					2.90	90.00	180.00	270.00					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												
H0435	003	0	1	01	01	H0435_003_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.45	45.00	90.00	112.50					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, Non-Preferred Brand, Specialty Tier												
H0435	003	0	1	01	01	H0435_003_0	8	5	Specialty Tier	1	4	100000	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	004	0	1	01	01	H0435_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									3.06	95.00	185.00	275.00					2.90	90.00	180.00	270.00					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												
H0435	004	0	1	01	01	H0435_004_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.45	45.00	90.00	112.50					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, Non-Preferred Brand, Specialty Tier												
H0435	004	0	1	01	01	H0435_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									0.55	17.00	29.00	35.00					0.39	12.00	24.00	30.00					0.39	12.00	24.00	30.00																		12.00				0.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	004	0	1	01	01	H0435_004_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.29	9.00	13.00	15.00					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, Non-Preferred Brand, Specialty Tier												
H0435	004	0	1	01	01	H0435_004_0	7	5	Specialty Tier	1	4	100000	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	005	0	1	01	01	H0435_005_0	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.06	95.00	185.00	275.00					2.90	90.00	180.00	270.00					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												
H0435	005	0	1	01	01	H0435_005_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.45	45.00	90.00	112.50					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, Non-Preferred Brand, Specialty Tier												
H0435	005	0	1	01	01	H0435_005_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.55	17.00	29.00	35.00					0.39	12.00	24.00	30.00					0.39	12.00	24.00	30.00																		12.00				0.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	005	0	1	01	01	H0435_005_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.29	9.00	13.00	15.00					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, Non-Preferred Brand, Specialty Tier												
H0435	005	0	1	01	01	H0435_005_0	7	5	Specialty Tier	1	4	100000	1	1		010	01	010		1				30				30						30		31														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	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		255.00																		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	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0439	001	0	1	01	01	H0439_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0439	001	0	1	01	01	H0439_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		9.00																		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	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					641.78	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	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		36.00																		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	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		9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0480	001	0	1	48	05	H0480_001_0	3	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	0.00	6.60	0.00	6.60			0.00	6.60			
H0480	001	0	1	48	05	H0480_001_0	3	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	0.00	2.65	0.00	2.65			0.00	2.65			
H0480	001	0	1	48	05	H0480_001_0	3	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	0.50	3.00	.50	1.00	1.50	3.00	.50	1.00			
H0490	004	0	1	01	01	H0490_004_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												
H0490	004	0	1	01	01	H0490_004_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												
H0490	004	0	1	01	01	H0490_004_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												
H0490	004	0	1	01	01	H0490_004_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												
H0504	015	0	1	01	01	H0504_015_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_0	6	6	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													2339.00	33	33	33					2339.00	33	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	6	2	Non-Preferred Generic	3	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31									0.30	9.00	18.00	27.00					0.16	5.00	10.00	10.00								10.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31									0.30	9.00	18.00	27.00					0.16	5.00	10.00	10.00								10.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	6	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31									1.50	45.00	90.00	135.00					1.33	40.00	80.00	80.00								80.00																		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	6	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31									3.00	90.00	180.00	270.00					2.83	85.00	170.00	170.00								170.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	6	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													176.00	25	25	25					176.00	25	25	25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	017	0	1	01	01	H0504_017_0	5	6	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													3669.00	33	33	33					3669.00	33	33	33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													210.00	25	25	25					210.00	25	25	25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	180.00								180.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	5	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31									1.50	45.00	90.00	135.00					1.33	40.00	80.00	80.00								80.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	5	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					0.17	5.00	10.00	10.00								10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	5	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					0.17	5.00	10.00	10.00								10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	021	0	1	01	01	H0504_021_0	7	1	Preferred Generic	3	4	001010	1	2		111	01	100		1				30	60	90	1			90				30		31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00								0.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	021	0	1	01	01	H0504_021_0	7	6	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													2037.00	33	33	33					2037.00	33	33	33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													202.00	25	25	25					202.00	25	25	25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31									2.33	70.00	140.00	210.00					2.17	65.00	130.00	130.00								130.00																		70.00				2.26	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31									1.17	35.00	70.00	105.00					1.00	30.00	60.00	60.00								60.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	6.00								6.00																		7.00				0.22	7.00		Preferred Generic, Non-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		111	01	100		1				30	60	90	1			90				30		31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00								0.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7	2	Non-Preferred Generic	3	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	6.00								6.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	021	0	1	01	01	H0504_021_0	7	3	Preferred Brand	3	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31									1.17	35.00	70.00	105.00					1.00	30.00	60.00	60.00								60.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	2	
H0504	026	0	1	01	01	H0504_026_0	5	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					0.17	5.00	10.00	10.00								10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	5	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31									1.50	45.00	90.00	135.00					1.33	40.00	80.00	80.00								80.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	180.00								180.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													186.00	25	25	25					186.00	25	25	25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	5	6	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													1442.00	33	33	33					1442.00	33	33	33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	026	0	1	01	01	H0504_026_0	5	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					0.17	5.00	10.00	10.00								10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	027	0	1	01	01	H0504_027_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31									0.30	9.00	18.00	27.00					0.17	5.00	10.00	10.00								10.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	027	0	1	01	01	H0504_027_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	027	0	1	01	01	H0504_027_0	5	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31									1.50	45.00	90.00	135.00					1.33	40.00	80.00	80.00								80.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	027	0	1	01	01	H0504_027_0	5	6	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													2315.00	33	33	33					2315.00	33	33	33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	027	0	1	01	01	H0504_027_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													119.00	25	25	25					119.00	25	25	25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	027	0	1	01	01	H0504_027_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31									3.00	90.00	180.00	270.00					2.83	85.00	170.00	170.00								170.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31									0.30	9.00	18.00	27.00					0.17	5.00	10.00	10.00								10.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	5	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31									1.50	45.00	90.00	135.00					1.33	40.00	80.00	80.00								80.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31									2.83	85.00	170.00	255.00					2.67	80.00	160.00	160.00								160.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	028	0	1	01	01	H0504_028_0	5	6	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													1759.00	33	33	33					1759.00	33	33	33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													148.00	25	25	25					148.00	25	25	25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	5	2	Non-Preferred Generic	3	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31									0.30	9.00	18.00	27.00					0.17	5.00	10.00	10.00								10.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	029	0	1	01	01	H0504_029_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31									0.30	9.00	18.00	27.00					0.17	5.00	10.00	10.00								10.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	5	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31									1.50	45.00	90.00	135.00					1.33	40.00	80.00	80.00								80.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31									3.00	90.00	180.00	270.00					2.83	85.00	170.00	170.00								170.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													143.00	25	25	25					143.00	25	25	25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	5	6	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													2724.00	33	33	33					2724.00	33	33	33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	029	0	1	01	01	H0504_029_0	5	2	Non-Preferred Generic	3	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31									0.30	9.00	18.00	27.00					0.17	5.00	10.00	10.00								10.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	030	0	1	01	01	H0504_030_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	030	0	1	01	01	H0504_030_0	6	6	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													2088.00	33	33	33					2088.00	33	33	33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	030	0	1	01	01	H0504_030_0	6	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					0.17	5.00	10.00	10.00								10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	030	0	1	01	01	H0504_030_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	030	0	1	01	01	H0504_030_0	6	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					0.17	5.00	10.00	10.00								10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	030	0	1	01	01	H0504_030_0	6	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31									1.50	45.00	90.00	135.00					1.33	40.00	80.00	80.00								80.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	030	0	1	01	01	H0504_030_0	6	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	180.00								180.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	030	0	1	01	01	H0504_030_0	6	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													167.00	25	25	25					167.00	25	25	25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	031	0	1	01	01	H0504_031_0	5	6	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													2054.00	33	33	33					2054.00	33	33	33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													166.00	25	25	25					166.00	25	25	25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	180.00								180.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	5	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31									1.50	45.00	90.00	135.00					1.33	40.00	80.00	80.00								80.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	5	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					0.17	5.00	10.00	10.00								10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	5	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					0.17	5.00	10.00	10.00								10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	032	0	1	01	01	H0504_032_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	032	0	1	01	01	H0504_032_0	5	6	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													2221.00	33	33	33					2221.00	33	33	33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													167.00	25	25	25					167.00	25	25	25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	180.00								180.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	5	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31									1.50	45.00	90.00	135.00					1.33	40.00	80.00	80.00								80.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	5	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					0.17	5.00	10.00	10.00								10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	5	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					0.17	5.00	10.00	10.00								10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0523	002	0	1	01	01	H0523_002_0	5	3	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	135.00												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												
H0523	002	0	1	01	01	H0523_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.40	12.00	24.00	36.00					.26	8.00	16.00	24.00												.40	12.00	24.00	36.00				.26	8.00	16.00	24.00					12.00			.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	002	0	1	01	01	H0523_002_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	002	0	1	01	01	H0523_002_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													38.83	50	50	50					36.11	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	022	0	1	01	01	H0523_022_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	022	0	1	01	01	H0523_022_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.33	10.00	20.00	30.00					.20	6.00	12.00	18.00												.33	10.00	20.00	30.00				.20	6.00	12.00	18.00					10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	022	0	1	01	01	H0523_022_0	5	3	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	135.00												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												
H0523	022	0	1	01	01	H0523_022_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													32.57	50	50	50					31.12	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	031	0	1	01	01	H0523_031_0	5	3	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	135.00												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												
H0523	031	0	1	01	01	H0523_031_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.16	5.00	10.00	15.00					.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												
H0523	031	0	1	01	01	H0523_031_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	031	0	1	01	01	H0523_031_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													29.83	50	50	50					25.85	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	052	0	1	01	01	H0523_052_0	5	1	Preferred Generic	1	4	001000	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												
H0523	052	0	1	01	01	H0523_052_0	5	2	Non-Preferred Generic	1	4	000100	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																			1.00			.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	052	0	1	01	01	H0523_052_0	5	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	1.16	35.00	70.00	105.00																					1.16	35.00	70.00	105.00																			35.00			1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	052	0	1	01	01	H0523_052_0	5	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					35.15	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	060	0	1	01	01	H0523_060_0	4	1	Preferred Generic	1	4	001000	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												
H0523	060	0	1	01	01	H0523_060_0	4	2	Non-Preferred Generic	1	4	000100	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	15.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	060	0	1	01	01	H0523_060_0	4	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					39.49	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	060	0	1	01	01	H0523_060_0	4	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	061	0	1	01	01	H0523_061_0	3	1	Preferred Generic	1	4	001000	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												
H0523	061	0	1	01	01	H0523_061_0	3	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	061	0	1	01	01	H0523_061_0	3	2	Non-Preferred Generic	1	4	000100	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	15.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	061	0	1	01	01	H0523_061_0	3	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					39.30	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	063	0	1	01	01	H0523_063_0	4	1	Preferred Generic	1	4	001000	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												
H0523	063	0	1	01	01	H0523_063_0	4	2	Non-Preferred Generic	1	4	000100	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	15.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	063	0	1	01	01	H0523_063_0	4	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0523	063	0	1	01	01	H0523_063_0	4	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					29.02	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H0524	002	0	2	01	01	H0524_002_0	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	002	0	2	01	01	H0524_002_0	9	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					895.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					878.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					913.00	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	8	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	9	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	9	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	9	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	9	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	9	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	010	0	2	01	01	H0524_010_0	9	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	9	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	9	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	9	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					884.00	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	11	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	11	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	11	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	11	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	11	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					893.00	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	11	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	11	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	013	0	1	01	01	H0524_013_0	11	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	11	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	015	0	1	01	01	H0524_015_0	9	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	9	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	9	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	9	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					937.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9	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	9	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	9	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	9	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	9	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	029	0	1	01	01	H0524_029_0	11	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	029	0	1	01	01	H0524_029_0	11	2	Non-Preferred Generic	1	3	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	029	0	1	01	01	H0524_029_0	11	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	11	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	11	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					894.00	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	11	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	11	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.56	17.00		51.00																					.56	17.00		34.00																		17.00				.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	030	0	1	01	01	H0524_030_0	11	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	11	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	030	0	1	01	01	H0524_030_0	11	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					784.00	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	11	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	11	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	031	0	1	01	01	H0524_031_0	9	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	031	0	1	01	01	H0524_031_0	9	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	9	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	9	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					1366.00	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	9	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	9	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	9	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	9	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	9	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	8	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	8	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	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					726.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	8	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	8	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	8	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	8	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	8	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	033	0	1	01	01	H0524_033_0	8	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	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					953.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					1210.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	8	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	8	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	8	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	034	0	1	01	01	H0524_034_0	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	035	0	1	01	01	H0524_035_0	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					939.00	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	8	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	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					622.00	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	8	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	8	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	8	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	9	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	037	0	1	01	01	H0524_037_0	9	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	9	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	9	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					922.00	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	9	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	9	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	037	0	1	01	01	H0524_037_0	9	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	9	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	9	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	8	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	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					974.00	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					956.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	8	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	8	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	8	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	8	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	8	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	040	0	1	01	01	H0524_040_0	8	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	8	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	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					963.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					978.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	042	0	1	01	01	H0524_042_0	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					1143.00	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	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					930.00	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	8	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	8	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	8	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	043	0	1	01	01	H0524_043_0	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					869.00	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	046	0	1	01	01	H0524_046_0	8	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	051	0	1	01	01	H0524_051_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				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												
H0524	051	0	1	01	01	H0524_051_0	11	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.66	20.00		60.00																					.66	20.00		40.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	11	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	051	0	1	01	01	H0524_051_0	11	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	051	0	1	01	01	H0524_051_0	11	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	051	0	1	01	01	H0524_051_0	11	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	051	0	1	01	01	H0524_051_0	11	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				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		
H0524	051	0	1	01	01	H0524_051_0	11	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.66	20.00		60.00																					.66	20.00		40.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	051	0	1	01	01	H0524_051_0	11	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					1212.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0543	001	0	1	01	01	H0543_001_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															12.00							8.00				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	2	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					643.00	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	2	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																															285.00							275.00				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	2	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	004	0	1	01	01	H0543_004_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															12.00							8.00				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	2	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																															285.00							275.00				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	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					682.00	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	2	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	2	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																															285.00							275.00				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	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					692.00	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	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															12.00							8.00				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	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	2	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																															285.00							275.00				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	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															12.00							8.00				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	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					628.00	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	2	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	2	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							275.00				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	2	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							125.00				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	2	5	Specialty Tier	1	3	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												
H0543	019	0	1	01	01	H0543_019_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.20	6.00		18.00																															18.00							12.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	2	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							18.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	2	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																															24.00							16.00				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	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					644.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	2	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							275.00				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	2	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							125.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															30.00							20.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					654.00	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	2	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							275.00				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	2	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							125.00				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	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					520.00	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	2	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																															24.00							16.00				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	2	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							125.00				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	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					606.00	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	2	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							125.00				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	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					845.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	3	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																															24.00							16.00				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	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	3	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							125.00				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	3	5	Specialty Tier	1	3	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												
H0543	036	0	1	01	01	H0543_036_0	3	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							275.00				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	2	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																															285.00							275.00				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	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	2	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															12.00							8.00				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	2	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	070	0	1	01	01	H0543_070_0	2	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							275.00				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	2	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							125.00				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	2	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																															27.00							18.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					511.00	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	2	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																															24.00							16.00				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	2	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							125.00				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	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					699.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	2	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																															24.00							16.00				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	2	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							275.00				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	2	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							125.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					656.00	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	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																															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	2	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							14.00				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	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	2	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																															285.00							275.00				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	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					667.00	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	2	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	2	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							14.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	2	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																															27.00							18.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	2	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							125.00				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	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					902.00	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	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																															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	2	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							14.00				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	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	2	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																															285.00							275.00				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	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					654.00	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	2	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	2	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							14.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	145	0	1	01	01	H0543_145_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															12.00							8.00				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	2	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	2	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																															285.00							275.00				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	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					694.00	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	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					728.00	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	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															30.00							20.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	2	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							125.00				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	2	5	Specialty Tier	1	3	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												
H0543	147	0	1	01	01	H0543_147_0	2	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							275.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															9.00							6.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					675.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	2	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							125.00				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	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																															30.00							20.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	2	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							14.00				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	2	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	151	0	1	01	01	H0543_151_0	2	5	Specialty Tier	1	4	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	151	0	1	01	01	H0543_151_0	2	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																															285.00							275.00				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	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	2	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							14.00				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	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																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															15.00							10.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	2	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.30	9.00		27.00																															27.00							18.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	2	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																															285.00							275.00				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	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					676.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0544	002	0	1	01	01	H0544_002_0	11	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.24	7.50		22.50																								18.75																		7.50				.24	7.50		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	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, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_0	11	6	Select Care Drugs	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	11	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					491.00	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	11	6	Select Care Drugs	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		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	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, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_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																								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	11	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.20	37.50		112.50																								93.75																		37.50				1.20	37.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	11	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.24	7.50		22.50																								18.75																		7.50				.24	7.50		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	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		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	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	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		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	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	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					2.40	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					3.89	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	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					3.32	25		25																							25																	25				25	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	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		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	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.24	7.50		22.50																								18.75																		7.50				.24	7.50		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	6	Select Care Drugs	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		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	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					491.00	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	1.20	37.50		112.50																								93.75																		37.50				1.20	37.50		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	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.24	7.50		22.50																								18.75																		7.50				.24	7.50		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	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	9	6	Select Care Drugs	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	9	6	Select Care Drugs	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		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	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	005	0	1	01	01	H0544_005_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.24	7.50		22.50																								18.75																		7.50				.24	7.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.20	37.50		112.50																								93.75																		37.50				1.20	37.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_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	005	0	1	01	01	H0544_005_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					491.00	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	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.24	7.50		22.50																								18.75																		7.50				.24	7.50		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	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	007	0	1	01	01	H0544_007_0	12	6	Select Care Drugs	1	4	010010	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	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.40	12.50		37.50																								31.25																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	12	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	007	0	1	01	01	H0544_007_0	12	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	12	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					491.00	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	12	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	008	0	1	01	01	H0544_008_0	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	12	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	12	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					2.74	85.00		255.00								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	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	12	6	Select Care Drugs	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																		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	12	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	12	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	008	0	1	01	01	H0544_008_0	12	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H0544	010	0	1	01	01	H0544_010_0	13	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	13	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	13	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	13	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					2.74	85.00		255.00								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	13	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	13	6	Select Care Drugs	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																		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	13	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H0544	010	0	1	01	01	H0544_010_0	13	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	13	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	012	0	1	01	01	H0544_012_0	12	6	Select Care Drugs	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																		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	12	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					2.74	85.00		255.00								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	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	12	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	12	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H0544	012	0	1	01	01	H0544_012_0	12	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	12	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	013	0	1	01	01	H0544_013_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																								0.00																		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	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																								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	13	6	Select Care Drugs	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		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	13	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.24	7.50		22.50																								18.75																		7.50				.24	7.50		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	13	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.20	37.50		112.50																								93.75																		37.50				1.20	37.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.24	7.50		22.50																								18.75																		7.50				.24	7.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_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																								0.00																		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	13	6	Select Care Drugs	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	13	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					491.00	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	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	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.24	7.50		22.50																								18.75																		7.50				.24	7.50		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	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		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	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		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	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	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.20	37.50		112.50																								93.75																		37.50				1.20	37.50		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	.24	7.50		22.50																								18.75																		7.50				.24	7.50		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					491.00	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	7	6	Select Care Drugs	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		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	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, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.24	7.50		22.50																								18.75																		7.50				.24	7.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.24	7.50		22.50																								18.75																		7.50				.24	7.50		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	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, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	7	6	Select Care Drugs	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					491.00	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	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																								212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.20	37.50		112.50																								93.75																		37.50				1.20	37.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	8	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					2.74	85.00		255.00								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	8	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	019	0	1	01	01	H0544_019_0	8	6	Select Care Drugs	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																		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	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	7	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					2.74	85.00		255.00								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	7	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	020	0	1	01	01	H0544_020_0	7	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H0544	020	0	1	01	01	H0544_020_0	7	6	Select Care Drugs	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																		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	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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								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	10	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.50	15.50		46.50					.33	10.50		31.50								26.25																		15.50				.50	15.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.32	10.00		30.00					0.16	5.00		15.00								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	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	10	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					2.90	90.00		270.00								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	10	6	Select Care Drugs	1	4	010010	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	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	8	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					2.74	85.00		255.00								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	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	8	6	Select Care Drugs	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																		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	8	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	024	0	1	01	01	H0544_024_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
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									0.16	5.00		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, 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									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
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									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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									0.16	5.00		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, Select Care Drugs										1		
H0544	025	0	1	01	01	H0544_025_0	8	6	Select Care Drugs	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																		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	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	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					2.74	85.00		255.00								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	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	8	6	Select Care Drugs	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																		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	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H0544	027	0	1	01	01	H0544_027_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	8	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	027	0	1	01	01	H0544_027_0	8	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					2.74	85.00		255.00								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	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H0544	031	0	1	01	01	H0544_031_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	8	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	031	0	1	01	01	H0544_031_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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	8	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					2.74	85.00		255.00								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	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	8	6	Select Care Drugs	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																		0.00				0.00	0.00		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									0.16	5.00		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, Select Care Drugs												
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													491.00	33							491.00	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	6	Select Care Drugs	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																		0.00				0.00	0.00		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	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
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									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
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									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	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									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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									3.06	95.00		285.00					2.74	85.00		255.00								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	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
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									3.06	95.00		285.00					2.74	85.00		255.00								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													491.00	33							491.00	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	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																		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									0.16	5.00		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, 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									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	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									0.16	5.00		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, Select Care Drugs										1		
H0544	037	0	1	01	01	H0544_037_0	9	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	037	0	1	01	01	H0544_037_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H0544	037	0	1	01	01	H0544_037_0	9	6	Select Care Drugs	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																		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	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					2.74	85.00		255.00								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	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					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_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					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_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					2.74	85.00		255.00								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	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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	9	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	038	0	1	01	01	H0544_038_0	9	6	Select Care Drugs	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																		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	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H0544	038	0	1	01	01	H0544_038_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	10	6	Select Care Drugs	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_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	041	0	1	01	01	H0544_041_0	10	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	10	6	Select Care Drugs	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		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	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	041	0	1	01	01	H0544_041_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, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	10	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				1			90				30		31					3.89	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	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					2.40	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	10	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					3.32	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	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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	001	0	1	01	01	H0545_001_0	7	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	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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0545	001	0	1	01	01	H0545_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1355.79	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	001	0	1	01	01	H0545_001_0	7	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	7	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	012	0	1	01	01	H0545_012_0	10	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	10	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	31		90				1			90				31		31	.09	3.00		9.00																								9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	012	0	1	01	01	H0545_012_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																								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	10	2	Non-Preferred Generic	3	4	000100	3	2	110		01	100		1	31		90				1			90				31		31	.09	3.00		9.00																								9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H0545	012	0	1	01	01	H0545_012_0	10	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	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					209.37	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	012	0	1	01	01	H0545_012_0	10	4	Non-Preferred Brand	1	4	100000	3	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												
H0545	013	0	1	01	01	H0545_013_0	7	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	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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	7	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	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1367.08	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	7	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	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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0562	009	0	1	01	01	H0562_009_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00												0.17	5.00	10.00	15.00				0.00	0.00	0.00	0.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	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					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	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	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	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.27	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.27	8.00	16.00	24.00				0.10	3.00	6.00	6.00				8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	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					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	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	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	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.27	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.27	8.00	16.00	24.00				0.10	3.00	6.00	6.00				8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	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					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	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	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	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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									0.27	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.27	8.00	16.00	24.00				0.10	3.00	6.00	6.00				8.00				0.23	8.00		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					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	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	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	1	Preferred Generic	3	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.27	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.27	8.00	16.00	24.00				0.10	3.00	6.00	6.00				8.00				0.23	8.00		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	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														33	33	33						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					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	055	0	1	01	01	H0562_055_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	055	0	1	01	01	H0562_055_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.10	33.00	66.00	99.00																												1.10	33.00	66.00	99.00				1.10	33.00	66.00	66.00				33.00				.97	33.00		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	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	055	0	1	01	01	H0562_055_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34						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	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	275.00				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	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	125.00				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	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	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					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00												0.17	5.00	10.00	15.00				0.00	0.00	0.00	0.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	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	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	4	5	Specialty Tier	1	3	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34						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	4	4	Non-Preferred Brand	1	3	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	275.00				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	4	3	Preferred Brand	1	3	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	125.00				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	4	2	Non-Preferred Generic	1	3	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.10	33.00	66.00	99.00																												1.10	33.00	66.00	99.00				1.10	33.00	66.00	66.00				33.00				.97	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	070	0	1	01	01	H0562_070_0	4	1	Preferred Generic	1	3	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	4	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	079	0	1	01	01	H0562_079_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	079	0	1	01	01	H0562_079_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	45.00				0.50	15.00	30.00	30.00				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	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	135.00				1.50	45.00	90.00	125.00				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	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	275.00				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	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				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, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_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	084	0	1	01	01	H0562_084_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00												0.17	5.00	10.00	15.00				0.00	0.00	0.00	0.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	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					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	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	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	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	089	0	1	01	01	H0562_089_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	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	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	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00												0.17	5.00	10.00	15.00				0.00	0.00	0.00	0.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	089	0	1	01	01	H0562_089_0	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					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	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					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		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									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00												0.17	5.00	10.00	15.00				0.00	0.00	0.00	0.00				5.00				0.14	5.00		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	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	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	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	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	30.00				.33	10.00	20.00	20.00				10.00				.29	10.00		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	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	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	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				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, Select Care Drugs												
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	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	275.00				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	135.00				1.50	45.00	90.00	125.00				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	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	30.00				.33	10.00	20.00	20.00				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	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	093	0	1	01	01	H0562_093_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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	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					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	093	0	1	01	01	H0562_093_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00												0.17	5.00	10.00	15.00				0.00	0.00	0.00	0.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	093	0	1	01	01	H0562_093_0	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	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	093	0	1	01	01	H0562_093_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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									.33	10.00	20.00	30.00					.17	5.00	10.00	15.00												.33	10.00	20.00	30.00				.17	5.00	10.00	10.00				10.00				.29	10.00		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	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	0.00				0.00				0.00	0.00		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														33	33	33						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	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.67	20.00	40.00	60.00					.50	15.00	30.00	45.00												.67	20.00	40.00	60.00				.50	15.00	30.00	30.00				20.00				.58	20.00		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	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	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	3	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.33	10.00	20.00	30.00					.17	5.00	10.00	15.00												.33	10.00	20.00	30.00				.17	5.00	10.00	10.00				10.00				.29	10.00		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	3	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.67	20.00	40.00	60.00					.50	15.00	30.00	45.00												.67	20.00	40.00	60.00				.50	15.00	30.00	30.00				20.00				.58	20.00		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	3	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														26	26	26						26	26	26												26	26	26					26	26	26			26				26	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	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	3	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	2	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	2	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					.33	10.00	20.00	30.00												.50	15.00	30.00	45.00				.33	10.00	20.00	20.00				15.00				.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	2	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.27	8.00	16.00	24.00					.10	3.00	6.00	9.00												.27	8.00	16.00	24.00				.10	3.00	6.00	6.00				8.00				.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	2	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	097	0	1	01	01	H0562_097_0	2	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	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	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					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		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									0.27	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.27	8.00	16.00	24.00				0.10	3.00	6.00	6.00				8.00				0.23	8.00		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	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	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	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	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	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				45.00				1.32	45.00		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									0.50	15.00	30.00	45.00					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		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									0.27	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.27	8.00	16.00	24.00				0.10	3.00	6.00	6.00				8.00				0.23	8.00		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	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	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	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	1	Preferred Generic	3	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.27	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.27	8.00	16.00	24.00				0.10	3.00	6.00	6.00				8.00				0.23	8.00		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	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					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		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	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	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	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.50	45.00	90.00	135.00					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	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									0.27	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.27	8.00	16.00	24.00				0.10	3.00	6.00	6.00				8.00				0.23	8.00		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									0.50	15.00	30.00	45.00					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		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	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	30.00				0.33	10.00	20.00	20.00				10.00				0.29	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	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	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	238.00				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	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				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, 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	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, 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	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	30.00				0.33	10.00	20.00	20.00				10.00				0.29	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	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	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	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	30.00				0.33	10.00	20.00	20.00				10.00				0.29	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	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, Select Care Drugs												
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	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	30.00				0.33	10.00	20.00	20.00				10.00				0.29	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						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	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	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	238.00				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	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	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	3	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.50	15.00	30.00	45.00												0.67	20.00	40.00	60.00				0.50	15.00	30.00	30.00				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	3	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					0.17	5.00	10.00	15.00												0.33	10.00	20.00	30.00				0.17	5.00	10.00	10.00				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	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	102	0	1	01	01	H0562_102_0	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	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					0.33	10.00	20.00	30.00												0.50	15.00	30.00	45.00				0.33	10.00	20.00	20.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.27	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.27	8.00	16.00	24.00				0.10	3.00	6.00	6.00				8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	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	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	104	0	1	01	01	H0562_104_0	3	4	Non-Preferred Brand	1	3	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	275.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	104	0	1	01	01	H0562_104_0	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	104	0	1	01	01	H0562_104_0	3	3	Preferred Brand	1	3	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	125.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	104	0	1	01	01	H0562_104_0	3	2	Non-Preferred Generic	1	3	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.00	30.00	60.00	90.00																												1.00	30.00	60.00	90.00				1.00	30.00	60.00	60.00				30.00				.88	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	104	0	1	01	01	H0562_104_0	3	5	Specialty Tier	1	3	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34						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	104	0	1	01	01	H0562_104_0	3	1	Preferred Generic	1	3	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	105	0	1	01	01	H0562_105_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.33	10.00	20.00	30.00					.17	5.00	10.00	15.00												.33	10.00	20.00	30.00				0.17	5.00	10.00	10.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	105	0	1	01	01	H0562_105_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.67	20.00	40.00	60.00					.50	15.00	30.00	45.00												.67	20.00	40.00	60.00				0.50	15.00	30.00	30.00				20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	105	0	1	01	01	H0562_105_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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	105	0	1	01	01	H0562_105_0	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	105	0	1	01	01	H0562_105_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	105	0	1	01	01	H0562_105_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	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	106	0	1	01	01	H0562_106_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	135.00				1.50	45.00	90.00	125.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	106	0	1	01	01	H0562_106_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	106	0	1	01	01	H0562_106_0	3	4	Non-Preferred Brand	3	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	275.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	106	0	1	01	01	H0562_106_0	3	3	Preferred Brand	3	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	125.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	106	0	1	01	01	H0562_106_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	45.00				0.50	15.00	30.00	30.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	106	0	1	01	01	H0562_106_0	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	275.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	106	0	1	01	01	H0562_106_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	106	0	1	01	01	H0562_106_0	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				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, Select Care Drugs												
H0562	106	0	1	01	01	H0562_106_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	45.00				0.50	15.00	30.00	30.00				15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	106	0	1	01	01	H0562_106_0	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.17	5.00	10.00	15.00																												0.17	5.00	10.00	15.00				0.17	5.00	10.00	10.00				5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	106	0	1	01	01	H0562_106_0	3	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.17	5.00	10.00	15.00																												0.17	5.00	10.00	15.00				0.17	5.00	10.00	10.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	108	0	1	01	01	H0562_108_0	3	4	Non-Preferred Brand	3	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	275.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	108	0	1	01	01	H0562_108_0	3	3	Preferred Brand	3	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	125.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	108	0	1	01	01	H0562_108_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	45.00				0.50	15.00	30.00	30.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	108	0	1	01	01	H0562_108_0	3	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.17	5.00	10.00	15.00																												0.17	5.00	10.00	15.00				0.17	5.00	10.00	10.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	108	0	1	01	01	H0562_108_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	108	0	1	01	01	H0562_108_0	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				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, Select Care Drugs												
H0562	108	0	1	01	01	H0562_108_0	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	285.00				3.17	95.00	190.00	275.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	108	0	1	01	01	H0562_108_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	135.00				1.50	45.00	90.00	125.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	108	0	1	01	01	H0562_108_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	108	0	1	01	01	H0562_108_0	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.17	5.00	10.00	15.00																												0.17	5.00	10.00	15.00				0.17	5.00	10.00	10.00				5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	108	0	1	01	01	H0562_108_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	45.00				0.50	15.00	30.00	30.00				15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_0	7	1	Preferred Generic	1	3	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	15.00					0.16	5.00	10.00	10.00																		5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_0	7	2	Non-Preferred Generic	1	3	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	30.00					0.33	10.00	20.00	20.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_0	7	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					1.03	31.00	62.00	93.00					1.03	31.00	93.00	93.00																		31.00				.91	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_0	7	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_0	7	5	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, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_0	7	6	Select Care Drugs	1	3	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												
H0564	056	0	1	01	01	H0564_056_0	8	6	Select Care Drugs	1	3	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												
H0564	056	0	1	01	01	H0564_056_0	8	5	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, Specialty Tier, Select Care Drugs												
H0564	056	0	1	01	01	H0564_056_0	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	056	0	1	01	01	H0564_056_0	8	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					1.03	31.00	62.00	93.00					1.03	31.00	93.00	93.00																		31.00				.91	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	056	0	1	01	01	H0564_056_0	8	2	Non-Preferred Generic	1	3	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	30.00					0.33	10.00	20.00	20.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	056	0	1	01	01	H0564_056_0	8	1	Preferred Generic	1	3	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	15.00					0.16	5.00	10.00	10.00																		5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	058	0	1	01	01	H0564_058_0	8	1	Preferred Generic	1	3	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	15.00					0.16	5.00	10.00	10.00																		5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	058	0	1	01	01	H0564_058_0	8	6	Select Care Drugs	1	3	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												
H0564	058	0	1	01	01	H0564_058_0	8	2	Non-Preferred Generic	1	3	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	30.00					0.33	10.00	20.00	20.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	058	0	1	01	01	H0564_058_0	8	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					1.03	31.00	62.00	93.00					1.03	31.00	93.00	93.00																		31.00				.91	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	058	0	1	01	01	H0564_058_0	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	058	0	1	01	01	H0564_058_0	8	5	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, Specialty Tier, Select Care Drugs												
H0564	059	0	1	01	01	H0564_059_0	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	059	0	1	01	01	H0564_059_0	8	6	Select Care Drugs	1	3	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												
H0564	059	0	1	01	01	H0564_059_0	8	5	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, Specialty Tier, Select Care Drugs												
H0564	059	0	1	01	01	H0564_059_0	8	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					1.03	31.00	62.00	93.00					1.03	31.00	93.00	93.00																		31.00				0.91	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	059	0	1	01	01	H0564_059_0	8	2	Non-Preferred Generic	1	3	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	30.00					0.33	10.00	20.00	20.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	059	0	1	01	01	H0564_059_0	8	1	Preferred Generic	1	3	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	15.00					0.16	5.00	10.00	10.00																		5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	060	0	1	01	01	H0564_060_0	12	6	Select Care Drugs	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												
H0564	060	0	1	01	01	H0564_060_0	12	5	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, Specialty Tier, Select Care Drugs												
H0564	060	0	1	01	01	H0564_060_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	060	0	1	01	01	H0564_060_0	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	060	0	1	01	01	H0564_060_0	12	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.83	25.00	50.00	75.00					0.66	20.00	40.00	60.00					0.66	20.00	40.00	40.00																		25.00				0.73	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	060	0	1	01	01	H0564_060_0	12	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	061	0	1	01	01	H0564_061_0	13	6	Select Care Drugs	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												
H0564	061	0	1	01	01	H0564_061_0	13	5	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, Specialty Tier, Select Care Drugs												
H0564	061	0	1	01	01	H0564_061_0	13	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	061	0	1	01	01	H0564_061_0	13	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	061	0	1	01	01	H0564_061_0	13	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.93	28.00	56.00	84.00					0.76	23.00	46.00	69.00					0.76	23.00	46.00	46.00																		28.00				0.82	28.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	061	0	1	01	01	H0564_061_0	13	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	14	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	14	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	14	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	14	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.86	26.00	52.00	78.00					0.70	21.00	42.00	63.00					0.70	21.00	42.00	42.00																		26.00				.76	26.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	14	6	Select Care Drugs	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												
H0564	062	0	1	01	01	H0564_062_0	14	5	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, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	12	6	Select Care Drugs	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												
H0564	063	0	1	01	01	H0564_063_0	12	5	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, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	12	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.80	24.00	48.00	72.00					0.63	19.00	38.00	57.00					0.63	19.00	38.00	38.00																		24.00				0.70	24.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	12	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	1	1	01	01	H0564_067_1	13	5	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, Specialty Tier, Select Care Drugs												
H0564	067	1	1	01	01	H0564_067_1	13	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.73	22.00	44.00	66.00					0.56	17.00	34.00	51.00					0.56	17.00	34.00	34.00																		22.00				.64	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	1	1	01	01	H0564_067_1	13	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	1	1	01	01	H0564_067_1	13	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	1	1	01	01	H0564_067_1	13	6	Select Care Drugs	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												
H0564	067	1	1	01	01	H0564_067_1	13	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	14	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	14	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.73	22.00	44.00	66.00					0.56	17.00	34.00	51.00					0.56	17.00	34.00	34.00																		22.00				.64	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	14	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	14	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	14	5	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, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	14	6	Select Care Drugs	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												
H0564	068	0	1	01	01	H0564_068_0	16	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.10	33.00	66.00	99.00					.93	28.00	56.00	84.00					.93	28.00	56.00	56.00																		33.00				.97	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	068	0	1	01	01	H0564_068_0	16	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	068	0	1	01	01	H0564_068_0	16	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	068	0	1	01	01	H0564_068_0	16	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	068	0	1	01	01	H0564_068_0	16	5	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, Specialty Tier, Select Care Drugs												
H0564	068	0	1	01	01	H0564_068_0	16	6	Select Care Drugs	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												
H0564	069	0	1	01	01	H0564_069_0	14	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	72.00					0.63	19.00	38.00	57.00					0.63	19.00	38.00	38.00																		24.00				0.70	24.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	069	0	1	01	01	H0564_069_0	14	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	069	0	1	01	01	H0564_069_0	14	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					1.16	35.00	70.00	105.00					1.16	35.00	105.00	105.00																		40.00				1.17	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	069	0	1	01	01	H0564_069_0	14	6	Select Care Drugs	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												
H0564	069	0	1	01	01	H0564_069_0	14	5	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, Specialty Tier, Select Care Drugs												
H0564	069	0	1	01	01	H0564_069_0	14	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					2.83	85.00	170.00	255.00					2.83	85.00	255.00	255.00																		90.00				2.64	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	13	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	13	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.73	22.00	44.00	66.00					.56	17.00	34.00	51.00					0.56	17.00	34.00	34.00																		22.00				.64	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	13	5	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, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	13	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	13	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	13	6	Select Care Drugs	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												
H0571	001	0	1	01	01	H0571_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	100		1				31	60	90	1			90					14	31									.09	3.00	6.00	9.00					.09	3.00	6.00	6.00								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	5	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	21.00					.22	7.00	14.00	14.00								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	5	5	Specialty Tier	1	4	100001	1	1		111	10	100		1				31	60	90	2			90					14	31													348.24	20	20	20					348.24	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	5	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	180.00					1.93	60.00	120.00	120.00								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	5	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	120.00					1.29	40.00	80.00	80.00								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	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													1312.89	33							1312.89	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	017	0	1	18	06	H0602_017_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		225.00					2.50	75.00		187.50								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	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	2			90				30		31									.10	3.00		9.00					.10	3.00		7.50								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	6	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	2			90				30		31									1.00	30.00		90.00					1.00	30.00		75.00								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	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	2			90				30		31									1.50	45.00		135.00					1.50	45.00		112.50								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	4	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													2873.69	33							2873.69	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	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	2			90				30		31									2.00	60.00		180.00					2.00	60.00		150.00								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	4	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	2			90				30		31									1.33	40.00		120.00					1.33	40.00		100.00								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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	2			90				30		31									.83	25.00		75.00					.83	25.00		62.50								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	4	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	2			90				30		31									.10	3.00		9.00					.10	3.00		7.50								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	4	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	2			90				30		31									.10	3.00		9.00					.10	3.00		7.50								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	4	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	2			90				30		31									.83	25.00		75.00					.83	25.00		62.50								62.50																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0602	020	0	1	18	06	H0602_020_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					.10	3.00		7.50								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	6	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	2			90				30		31									1.00	30.00		90.00					1.00	30.00		75.00								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	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	2			90				30		31									1.50	45.00		135.00					1.50	45.00		112.50								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	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	2			90				30		31									2.50	75.00		225.00					2.50	75.00		187.50								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	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													1503.17	33							1503.17	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	4	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	2			90				30		31									.10	3.00		9.00					.10	3.00		7.50								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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	2			90				30		31									1.00	30.00		90.00					1.00	30.00		75.00								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	4	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	2			90				30		31									1.50	45.00		135.00					1.50	45.00		112.50								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	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	2			90				30		31									2.50	75.00		225.00					2.50	75.00		187.50								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	4	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													1306.21	33							1306.21	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	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	2			90				30		31									1.33	40.00		120.00					1.33	40.00		100.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	039	0	1	18	06	H0602_039_0	6	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	2			90				30		31									.83	25.00		75.00					.83	25.00		62.50								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	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	2			90				30		31									.10	3.00		9.00					.10	3.00		7.50								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	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	2			90				30		31									3.00	90.00		270.00					3.00	90.00		225.00								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	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													638.57	31							638.57	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	2	Non-Preferred Generic	1	3	000110	1	2		110	01	100		1				30		90	2			90				30		31									.83	25.00		75.00					.83	25.00		62.50								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	1	Preferred Generic	1	3	001000	1	2		110	01	100		1				30		90	2			90				30		31									.10	3.00		9.00					.10	3.00		7.50								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	3	Preferred Brand	1	3	010001	1	2		110	01	100		1				30		90	2			90				30		31									1.33	40.00		120.00					1.33	40.00		100.00								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		240.00					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												
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													1069.87	30							1069.87	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	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_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												
H0609	007	0	1	01	01	H0609_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																															24.00							16.00				8.00				0.25	8.00		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	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		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	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				45.00				1.45	45.00		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	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					628.00	33		33																														33							33			33				33	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	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															285.00							275.00				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	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		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	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															24.00							16.00				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	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															285.00							275.00				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	3	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												
H0609	020	0	1	01	01	H0609_020_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		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	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															24.00							16.00				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	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							275.00				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	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				45.00				1.45	45.00		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	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					684.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	006	0	1	01	01	H0621_006_0	9	2	Non-Preferred Generic	1	3	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					0.00	0.00		0.00															8.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	006	0	1	01	01	H0621_006_0	9	3	Preferred Brand	1	3	000001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.30	39.00		117.00															90.00							78.00				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	9	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					2.96	89.00		267.00															190.00							178.00				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	9	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31													599.00	25							599.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	006	0	1	01	01	H0621_006_0	9	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							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	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					0.00	0.00		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	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01		100	1				30		90	1						90	30		31									.50	15.00		45.00					.36	11.00		33.00															30.00							22.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	010	0	1	01	01	H0621_010_0	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31													655.00	25							655.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	010	0	1	01	01	H0621_010_0	7	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					2.96	89.00		267.00															190.00							178.00				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	7	3	Preferred Brand	1	3	000001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.30	39.00		117.00															90.00							78.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0630	013	0	1	01	01	H0630_013_0	8	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	8	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	013	0	1	01	01	H0630_013_0	8	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	8	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	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					1461.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	11	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	11	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	11	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	11	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	11	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					1374.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	11	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	11	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	11	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	11	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	016	0	1	01	01	H0630_016_0	8	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				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	8	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	8	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	8	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	8	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	8	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	8	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	016	0	1	01	01	H0630_016_0	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					1328.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	8	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	8	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	8	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	017	0	1	01	01	H0630_017_0	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					1860.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	018	0	1	01	01	H0630_018_0	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					1606.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	8	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	8	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	020	0	1	01	01	H0630_020_0	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					1405.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					1178.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0712	005	0	1	01	01	H0712_005_0	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				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	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														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	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.53	16.00		48.00					.06	2.00		6.00												0.53	16.00		48.00				0.06	2.00		5.00				16.00				0.51	16.00		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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.66	80.00		240.00												3.16	95.00		285.00				2.66	80.00		200.00				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.16	35.00		105.00												1.50	45.00		135.00				1.16	35.00		87.50				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.20	6.00		18.00					0.10	3.00		9.00												0.20	6.00		18.00				0.10	3.00		0.00				6.00				0.19	6.00		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		110	01		110	1				30		90	1				30		90	30		31									0.66	20.00		60.00					0.43	13.00		39.00												0.66	20.00		60.00				0.43	13.00		32.50				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	7	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.46	14.00		42.00					.06	2.00		6.00												0.46	14.00		42.00				.06	2.00		5.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	7	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.03	31.00		93.00												1.50	45.00		135.00				1.03	31.00		77.50				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	7	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	7	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.16	65.00		195.00												3.16	95.00		285.00				2.16	65.00		162.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	7	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					0.00	0.00		0.00												0.33	10.00		30.00				0.00	0.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					679.00	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	2	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							275.00				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	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					608.00	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	2	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							125.00				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	2	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							275.00				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	2	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																															27.00							18.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															9.00							6.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					610.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_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																															30.00							20.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0773	001	0	1	48	05	H0773_001_0	3	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 Drugs, Non-Medicare OTC 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	3	3	Non-Medicare Rx Drugs	1	4	010000			110		01	111		1	30		90				1	30	60	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			
H0773	001	0	1	48	05	H0773_001_0	3	4	Non-Medicare OTC Drugs	1	4	000010			110		01	111		1	30		90				1	30	60	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			
H0773	001	0	1	48	05	H0773_001_0	3	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 Drugs, Non-Medicare OTC Drugs	1	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
H0811	001	0	1	49	05	H0811_001_0	5	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 Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0811	001	0	1	49	05	H0811_001_0	5	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 Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0811	001	0	1	49	05	H0811_001_0	5	3	Non-Medicare Rx Drugs	1	4	010010			111		01	111		1	30	60	90				2	30	60	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			
H0811	001	0	1	49	05	H0811_001_0	5	4	Non-Medicare OTC Drugs	1	4	010010			111		01	111		1	30	60	90				2	30	60	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			
H0838	024	0	1	01	01	H0838_024_0	14	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	.32	10.00		30.00																								30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	14	2	Non-Preferred Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31					7.58	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	14	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					497.25	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	14	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					45.02	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	14	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31					20.94	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	14	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, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	13	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					655.61	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	13	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, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	13	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	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, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	13	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, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	13	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	13	6	Select Diabetic Drugs	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	025	0	1	01	01	H0838_025_0	13	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	025	0	1	01	01	H0838_025_0	13	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, Select Diabetic Drugs										1		
H0838	026	0	1	01	01	H0838_026_0	13	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, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	13	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	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, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	13	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, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	13	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					663.84	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	13	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	13	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, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	13	2	Non-Preferred Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31					4.85	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	13	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					467.14	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	13	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					41.34	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	13	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31					19.20	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	13	6	Select Diabetic Drugs	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, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	13	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	028	0	1	01	01	H0838_028_0	13	6	Select Diabetic Drugs	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	028	0	1	01	01	H0838_028_0	13	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, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	13	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	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, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	13	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, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	13	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					649.37	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	13	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	13	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, Select Diabetic Drugs										1		
H0838	029	0	1	01	01	H0838_029_0	14	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					42.43	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	14	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31					19.64	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	14	2	Non-Preferred Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31					7.57	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	14	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, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	14	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					488.50	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	14	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	.32	10.00		30.00																								30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	13	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, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	13	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	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, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	13	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, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	13	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					653.45	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	13	6	Select Diabetic Drugs	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	030	0	1	01	01	H0838_030_0	13	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	030	0	1	01	01	H0838_030_0	13	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, Select Diabetic Drugs										1		
H0838	030	0	1	01	01	H0838_030_0	13	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	14	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, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	14	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					487.63	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	14	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					42.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	14	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31					19.42	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	14	2	Non-Preferred Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31					7.57	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	14	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.32	10.00		30.00																								30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	13	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, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	13	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	13	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					651.48	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	13	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, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	13	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	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, Select Diabetic Drugs												
H0840	001	0	1	04	01	H0840_001_0	10	2	Non-Preferred Generic	1	4	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	.67	20.00	40.00	60.00																					.67	20.00	20.00	20.00																			20.00			.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0840	001	0	1	04	01	H0840_001_0	10	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	10	3	Preferred Brand	1	4	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	1.17	35.00	70.00	105.00																					1.17	35.00	35.00	35.00																			35.00			1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0840	001	0	1	04	01	H0840_001_0	10	4	Non-Preferred Brand	1	4	100100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	3.00	90.00	180.00	270.00																					3.00	90.00	90.00	90.00																			90.00			2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0840	001	0	1	04	01	H0840_001_0	10	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	10	1	Preferred Generic	3	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										1		
H0879	001	0	1	04	01	H0879_001_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				31		90	1			90				31		34									0.32	10.00		25.00					0.00	0.00		0.00								25.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0879	001	0	1	04	01	H0879_001_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		90	1			90				31		34									0.10	3.00		7.50					0.00	0.00		0.00								7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0879	001	0	1	04	01	H0879_001_0	9	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, Vaccines												
H0879	001	0	1	04	01	H0879_001_0	9	6	Vaccines	1	4	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				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0879	001	0	1	04	01	H0879_001_0	9	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, Vaccines												
H0879	001	0	1	04	01	H0879_001_0	9	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, Vaccines												
H0879	002	0	1	04	01	H0879_002_0	11	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		90	1			90				31		34									0.16	5.00		12.50					0.00	0.00		0.00								12.50																		5.00				0.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0879	002	0	1	04	01	H0879_002_0	11	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, Vaccines												
H0879	002	0	1	04	01	H0879_002_0	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				31		90	1			90				31		34									0.48	15.00		37.50					0.16	5.00		12.50								37.50																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0879	002	0	1	04	01	H0879_002_0	11	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, Vaccines												
H0879	002	0	1	04	01	H0879_002_0	11	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, Vaccines												
H0879	002	0	1	04	01	H0879_002_0	11	6	Vaccines	1	4	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				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0901	004	0	1	01	01	H0901_004_0	6	3	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	135.00												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												
H0901	004	0	1	01	01	H0901_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.53	16.00	32.00	48.00					0.40	12.00	24.00	36.00												0.53	16.00	32.00	48.00				0.40	12.00	24.00	36.00					16.00			0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0901	004	0	1	01	01	H0901_004_0	6	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.30	9.00	18.00	27.00					0.16	5.00	10.00	15.00												0.30	9.00	18.00	27.00				0.16	5.00	10.00	15.00					9.00			0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0901	004	0	1	01	01	H0901_004_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													44.68	50	50	50					42.92	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0901	004	0	1	01	01	H0901_004_0	6	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.26	38.00		114.00												1.50	45.00		135.00				1.26	38.00		95.00				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		110	01		110	1				30		90	1				30		90	30		31									0.83	25.00		75.00					.50	15.00		45.00												.83	25.00		75.00				.50	15.00		37.50				25.00				0.80	25.00		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		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					.13	4.00		12.00												.33	10.00		30.00				.13	4.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	002	0	1	01	01	H0913_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.93	88.00		264.00												3.16	95.00		285.00				2.93	88.00		220.00				95.00				3.06	95.00		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				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	012	0	1	01	01	H0913_012_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					.13	4.00		12.00												.33	10.00		30.00				.13	4.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	012	0	1	01	01	H0913_012_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.83	25.00		75.00					.50	15.00		45.00												.83	25.00		75.00				.50	15.00		37.50				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	012	0	1	01	01	H0913_012_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		135.00					1.26	38.00		114.00												1.50	45.00		135.00				1.26	38.00		95.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	012	0	1	01	01	H0913_012_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.93	88.00		264.00												3.16	95.00		285.00				2.93	88.00		220.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	012	0	1	01	01	H0913_012_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	4	1	Generic Drugs	1	4	010000			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	4	2	Brand Drugs	1	4	000110			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	4	3	Non-Medicare OTC Drugs	1	4	000001			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			
H1013	011	0	1	01	01	H1013_011_0	6	1	Generic	1	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.10	3.00	6.00	6.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			3.00			.09	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	011	0	1	01	01	H1013_011_0	6	2	Preferred Brand	1	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.50	15.00	30.00	30.00					.16	5.00	10.00	10.00					.16	5.00	10.00	10.00																			15.00			.48	15.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	011	0	1	01	01	H1013_011_0	6	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													47.34	50	50	50					47.88	50	50	50					50	50	50																		50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	011	0	1	01	01	H1013_011_0	6	4	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	011	0	1	01	01	H1013_011_0	6	1	Generic	3	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	10.00					.10	3.00	6.00	6.00					.10	3.00	6.00	6.00																			5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1013	021	0	1	01	01	H1013_021_0	4	1	Generic	1	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	021	0	1	01	01	H1013_021_0	4	2	Preferred Brand	1	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.00	30.00	60.00	60.00					.66	20.00	40.00	40.00					.66	20.00	40.00	40.00																			30.00			.96	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	021	0	1	01	01	H1013_021_0	4	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													45.72	50	50	50					45.81	50	50	50					50	50	50																		50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	021	0	1	01	01	H1013_021_0	4	4	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	024	0	1	01	01	H1013_024_0	7	1	Generic	1	4	010010	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	024	0	1	01	01	H1013_024_0	7	2	Preferred Brand	1	4	010001	3	2	111		10	111		1	30	60	90				1	30	60	90					10	31	1.50	45.00	90.00	90.00																					1.50	45.00	90.00	90.00																			45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	024	0	1	01	01	H1013_024_0	7	4	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	024	0	1	01	01	H1013_024_0	7	3	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					51.72	50	50	50																					50	50	50																		50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	029	0	1	01	01	H1013_029_0	4	4	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	029	0	1	01	01	H1013_029_0	4	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													32.87	50	50	50					30.92	50	50	50					50	50	50																		50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	029	0	1	01	01	H1013_029_0	4	2	Preferred Brand	1	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.50	45.00	90.00	90.00					1.16	35.00	70.00	70.00					1.16	35.00	70.00	70.00																			45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	029	0	1	01	01	H1013_029_0	4	1	Generic	1	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	030	0	1	01	01	H1013_030_0	9	3	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					44.39	50	50	50																					50	50	50																		50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	030	0	1	01	01	H1013_030_0	9	4	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	030	0	1	01	01	H1013_030_0	9	2	Preferred Brand	1	4	010001	3	2	111		10	111		1	30	60	90				1	30	60	90					10	31	1.50	45.00	90.00	90.00																					1.50	45.00	90.00	90.00																			45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	030	0	1	01	01	H1013_030_0	9	1	Generic	3	4	010010	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1013	030	0	1	01	01	H1013_030_0	9	1	Generic	1	4	010010	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	031	0	1	01	01	H1013_031_0	8	1	Generic	1	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	031	0	1	01	01	H1013_031_0	8	2	Preferred Brand	1	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.66	20.00	40.00	40.00					.33	10.00	20.00	20.00					.33	10.00	20.00	20.00																			20.00			.64	20.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	031	0	1	01	01	H1013_031_0	8	1	Generic	3	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	20.00					.16	5.00	10.00	10.00					.16	5.00	10.00	10.00																			10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1013	031	0	1	01	01	H1013_031_0	8	4	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	031	0	1	01	01	H1013_031_0	8	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													36.62	50	50	50					36.88	50	50	50					50	50	50																		50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	032	0	1	01	01	H1013_032_0	6	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													49.48	50	50	50					51.65	50	50	50					50	50	50																		50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	032	0	1	01	01	H1013_032_0	6	2	Preferred Brand	1	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	20.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	032	0	1	01	01	H1013_032_0	6	1	Generic	1	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	032	0	1	01	01	H1013_032_0	6	4	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	032	0	1	01	01	H1013_032_0	6	1	Generic	3	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		1
H1013	032	0	1	01	01	H1013_032_0	6	2	Preferred Brand	3	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.50	15.00	30.00	30.00					.16	5.00	10.00	10.00					.16	5.00	10.00	10.00																			15.00			.48	15.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		1
H1013	033	0	1	01	01	H1013_033_0	5	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													38.92	50	50	50					37.81	50	50	50					50	50	50																		50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	033	0	1	01	01	H1013_033_0	5	2	Preferred Brand	1	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	70.00					.83	25.00	50.00	50.00					1.16	35.00	70.00	70.00																			35.00			1.12	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	033	0	1	01	01	H1013_033_0	5	1	Generic	1	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	033	0	1	01	01	H1013_033_0	5	4	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	033	0	1	01	01	H1013_033_0	5	1	Generic	3	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1013	034	0	1	01	01	H1013_034_0	5	4	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	034	0	1	01	01	H1013_034_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					45.96	50	50	50																					50	50	50																		50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	034	0	1	01	01	H1013_034_0	5	2	Preferred Brand	1	4	010001	3	2	111		10	111		1	30	60	90				1	30	60	90					10	31	1.50	45.00	90.00	90.00																					1.50	45.00	90.00	90.00																			45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	034	0	1	01	01	H1013_034_0	5	1	Generic	1	4	010010	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	035	0	1	01	01	H1013_035_0	8	2	Preferred Brand	1	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	70.00					.83	25.00	50.00	50.00					.83	25.00	50.00	50.00																			35.00			1.12	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	035	0	1	01	01	H1013_035_0	8	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													32.80	50	50	50					31.25	50	50	50					50	50	50																		50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	035	0	1	01	01	H1013_035_0	8	4	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	035	0	1	01	01	H1013_035_0	8	1	Generic	3	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1013	035	0	1	01	01	H1013_035_0	8	1	Generic	1	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	9	1	Preferred Generic	1	4	001000	3	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												
H1016	001	0	1	01	01	H1016_001_0	9	2	Non-Preferred Generic	1	4	000101	3	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												
H1016	001	0	1	01	01	H1016_001_0	9	3	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	.83	25.00	50.00	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	9	4	Non-Preferred Brand	1	4	100000	3	2	111		01	100		1	30	60	90				1			90				30		31	1.66	50.00	100.00	150.00																								150.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	9	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	9	1	Preferred Generic	3	4	001000	3	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										1		3
H1016	001	0	1	01	01	H1016_001_0	9	2	Non-Preferred Generic	3	4	000101	3	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										1		3
H1016	021	0	1	01	01	H1016_021_0	7	1	Preferred Generic	1	4	001000	3	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												
H1016	021	0	1	01	01	H1016_021_0	7	2	Non-Preferred Generic	1	4	000101	3	2	111		01	100		1	30	60	90				1			90				30		31	0.23	7.00	14.00	21.00																								21.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	7	3	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	1.16	35.00	70.00	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	7	4	Non-Preferred Brand	1	4	100000	3	2	111		01	100		1	30	60	90				1			90				30		31	2.33	70.00	140.00	210.00																								210.00																		70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	7	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	7	1	Preferred Generic	3	4	001000	3	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										1		3
H1016	021	0	1	01	01	H1016_021_0	7	2	Non-Preferred Generic	3	4	000101	3	2	111		01	100		1	30	60	90				1			90				30		31	.23	7.00	14.00	21.00																								21.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1019	001	0	1	01	01	H1019_001_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	001	0	1	01	01	H1019_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		150.00				1.66	50.00		140.00				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	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		60.00				0.66	20.00		50.00				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	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	001	0	1	01	01	H1019_001_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		3
H1019	001	0	1	01	01	H1019_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		150.00				1.66	50.00		140.00				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	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		60.00				0.66	20.00		50.00				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	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	006	0	1	01	01	H1019_006_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		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										2	3	
H1019	006	0	1	01	01	H1019_006_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	3	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	
H1019	006	0	1	01	01	H1019_006_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	006	0	1	01	01	H1019_006_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		3
H1019	006	0	1	01	01	H1019_006_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1019	006	0	1	01	01	H1019_006_0	3	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												
H1019	006	0	1	01	01	H1019_006_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	006	0	1	01	01	H1019_006_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	010	0	1	01	01	H1019_010_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	010	0	1	01	01	H1019_010_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H1019	010	0	1	01	01	H1019_010_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		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										2	3	
H1019	010	0	1	01	01	H1019_010_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	010	0	1	01	01	H1019_010_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	010	0	1	01	01	H1019_010_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1019	010	0	1	01	01	H1019_010_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		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												
H1019	010	0	1	01	01	H1019_010_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	014	0	1	01	01	H1019_014_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		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										2	3	
H1019	014	0	1	01	01	H1019_014_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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	014	0	1	01	01	H1019_014_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	014	0	1	01	01	H1019_014_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		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												
H1019	014	0	1	01	01	H1019_014_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		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												
H1019	014	0	1	01	01	H1019_014_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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	
H1019	014	0	1	01	01	H1019_014_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	014	0	1	01	01	H1019_014_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		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										2	3	
H1019	023	0	1	01	01	H1019_023_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	023	0	1	01	01	H1019_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		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												
H1019	023	0	1	01	01	H1019_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		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												
H1019	023	0	1	01	01	H1019_023_0	4	5	Specialty Tier	1	4	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												
H1019	023	0	1	01	01	H1019_023_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	024	0	1	01	01	H1019_024_0	5	5	Specialty Tier	1	4	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												
H1019	024	0	1	01	01	H1019_024_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	024	0	1	01	01	H1019_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		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												
H1019	024	0	1	01	01	H1019_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		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												
H1019	024	0	1	01	01	H1019_024_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	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	025	0	1	01	01	H1019_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												
H1019	025	0	1	01	01	H1019_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		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												
H1019	025	0	1	01	01	H1019_025_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		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												
H1019	025	0	1	01	01	H1019_025_0	4	5	Specialty Tier	1	4	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												
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		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												
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		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												
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	0.20	6.00		18.00																												0.20	6.00		18.00				0.20	6.00		0.00				6.00				0.19	6.00		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	5	Specialty Tier	1	4	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												
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	2.83	85.00		255.00																												2.83	85.00		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												
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		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												
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	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		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	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						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	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	2.83	85.00		255.00																												2.83	85.00		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										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		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										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	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	027	0	1	01	01	H1019_027_0	5	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	
H1019	028	0	1	01	01	H1019_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		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												
H1019	028	0	1	01	01	H1019_028_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	028	0	1	01	01	H1019_028_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	028	0	1	01	01	H1019_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		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												
H1019	028	0	1	01	01	H1019_028_0	5	5	Specialty Tier	1	4	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												
H1019	032	0	1	01	01	H1019_032_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		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										2	3	
H1019	032	0	1	01	01	H1019_032_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		150.00				1.66	50.00		140.00				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	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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	032	0	1	01	01	H1019_032_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	032	0	1	01	01	H1019_032_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		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												
H1019	032	0	1	01	01	H1019_032_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		150.00				1.66	50.00		140.00				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	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		3
H1019	032	0	1	01	01	H1019_032_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	043	0	1	01	01	H1019_043_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	043	0	1	01	01	H1019_043_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		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_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		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												
H1019	043	0	1	01	01	H1019_043_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		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												
H1019	043	0	1	01	01	H1019_043_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	043	0	1	01	01	H1019_043_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	
H1019	043	0	1	01	01	H1019_043_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		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	043	0	1	01	01	H1019_043_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		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										2	3	
H1019	043	0	1	01	01	H1019_043_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		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										2	3	
H1019	043	0	1	01	01	H1019_043_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1019	054	0	1	01	01	H1019_054_0	3	3	Preferred Brand	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		45.00				0.50	15.00		35.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_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	054	0	1	01	01	H1019_054_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		3
H1019	054	0	1	01	01	H1019_054_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	054	0	1	01	01	H1019_054_0	3	3	Preferred Brand	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		45.00				0.50	15.00		35.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	054	0	1	01	01	H1019_054_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		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										2	3	
H1019	054	0	1	01	01	H1019_054_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	057	0	1	01	01	H1019_057_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1019	057	0	1	01	01	H1019_057_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		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												
H1019	057	0	1	01	01	H1019_057_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		30.00				0.33	10.00		0.00				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	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	057	0	1	01	01	H1019_057_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	057	0	1	01	01	H1019_057_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H1019	057	0	1	01	01	H1019_057_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		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										2	3	
H1019	057	0	1	01	01	H1019_057_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, Select Care Drugs												
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	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	1.16	35.00		105.00																												1.16	35.00		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 Care Drugs												
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	2.83	85.00		255.00																												2.83	85.00		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, Select Care Drugs												
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						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1019	059	0	1	01	01	H1019_059_0	3	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										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, Select Care Drugs										2	3	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						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
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	2.83	85.00		255.00																												2.83	85.00		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, Select Care Drugs										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	1.16	35.00		105.00																												1.16	35.00		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 Care Drugs										2	3	
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	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1019	059	0	1	01	01	H1019_059_0	3	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1019	060	0	1	01	01	H1019_060_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		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										2	3	
H1019	060	0	1	01	01	H1019_060_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		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										2	3	
H1019	060	0	1	01	01	H1019_060_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	060	0	1	01	01	H1019_060_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1019	060	0	1	01	01	H1019_060_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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	
H1019	060	0	1	01	01	H1019_060_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	060	0	1	01	01	H1019_060_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		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												
H1019	062	0	1	01	01	H1019_062_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	062	0	1	01	01	H1019_062_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	062	0	1	01	01	H1019_062_0	5	3	Preferred Brand	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		45.00				0.50	15.00		35.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	062	0	1	01	01	H1019_062_0	5	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		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												
H1019	062	0	1	01	01	H1019_062_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	062	0	1	01	01	H1019_062_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	
H1019	062	0	1	01	01	H1019_062_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	062	0	1	01	01	H1019_062_0	5	3	Preferred Brand	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		45.00				0.50	15.00		35.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	062	0	1	01	01	H1019_062_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	5	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		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										2	3	
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						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		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										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		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										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						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		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												
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		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												
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	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	064	0	1	01	01	H1019_064_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H1019	064	0	1	01	01	H1019_064_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		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										2	3	
H1019	064	0	1	01	01	H1019_064_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	064	0	1	01	01	H1019_064_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	064	0	1	01	01	H1019_064_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	064	0	1	01	01	H1019_064_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		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												
H1019	064	0	1	01	01	H1019_064_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		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												
H1019	064	0	1	01	01	H1019_064_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	064	0	1	01	01	H1019_064_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	
H1019	065	0	1	01	01	H1019_065_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	065	0	1	01	01	H1019_065_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	065	0	1	01	01	H1019_065_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		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										2	3	
H1019	065	0	1	01	01	H1019_065_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		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										2	3	
H1019	065	0	1	01	01	H1019_065_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	065	0	1	01	01	H1019_065_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		18.00				0.20	6.00		0.00				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	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1019	065	0	1	01	01	H1019_065_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		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												
H1019	065	0	1	01	01	H1019_065_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	066	0	1	01	01	H1019_066_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, Select Care Drugs												
H1019	066	0	1	01	01	H1019_066_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1019	066	0	1	01	01	H1019_066_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1019	066	0	1	01	01	H1019_066_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		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, Select Care Drugs										2	3	
H1019	066	0	1	01	01	H1019_066_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		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 Care Drugs										2	3	
H1019	066	0	1	01	01	H1019_066_0	4	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1019	066	0	1	01	01	H1019_066_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, Select Care Drugs										2	3	3
H1019	066	0	1	01	01	H1019_066_0	4	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1019	066	0	1	01	01	H1019_066_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1019	066	0	1	01	01	H1019_066_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		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, Select Care Drugs												
H1019	066	0	1	01	01	H1019_066_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		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 Care Drugs												
H1019	066	0	1	01	01	H1019_066_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
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		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												
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	2.83	85.00		255.00																												2.83	85.00		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												
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						33																														33							33					33				33	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	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	
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	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		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		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										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	2.83	85.00		255.00																												2.83	85.00		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										2	3	
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						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	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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	0.23	7.00		21.00																												0.23	7.00		21.00				0.23	7.00		0.00				7.00				0.22	7.00		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		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												
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		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												
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						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	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	
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	0.23	7.00		21.00																												0.23	7.00		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	069	0	1	01	01	H1019_069_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		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										2	3	
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		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										2	3	
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						33																														33							33					33				33	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	1.50	45.00		135.00																												1.50	45.00		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												
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	3.16	95.00		285.00																												3.16	95.00		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												
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	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	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	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	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		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										2	3	
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	3.16	95.00		285.00																												3.16	95.00		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										2	3	
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						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	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		3
H1019	071	0	1	01	01	H1019_071_0	6	5	Specialty Tier	1	3	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												
H1019	071	0	1	01	01	H1019_071_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		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												
H1019	071	0	1	01	01	H1019_071_0	6	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		126.00				1.40	42.00		116.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	071	0	1	01	01	H1019_071_0	6	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		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												
H1019	071	0	1	01	01	H1019_071_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												
H1019	073	0	1	01	01	H1019_073_0	4	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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_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		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												
H1019	073	0	1	01	01	H1019_073_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		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												
H1019	073	0	1	01	01	H1019_073_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_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												
H1019	074	0	1	01	01	H1019_074_0	6	5	Specialty Tier	1	3	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												
H1019	074	0	1	01	01	H1019_074_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		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												
H1019	074	0	1	01	01	H1019_074_0	6	2	Non-Preferred Generic	1	3	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	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												
H1019	074	0	1	01	01	H1019_074_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		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												
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						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	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		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										2	3	
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		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										2	3	
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	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	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
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		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												
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	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	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						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	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		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										2	3	
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		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										2	3	
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	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	
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						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	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		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												
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		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												
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	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												
H1026	001	0	1	01	01	H1026_001_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					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				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	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					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				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	8	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									.96	30.00		90.00					.80	25.00		75.00					.80	25.00		75.00																		30.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	8	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				31		90	1	31		90				31		31									1.77	55.00		165.00					1.61	50.00		150.00					1.61	50.00		150.00																		55.00				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	8	5	Specialty Tier	1	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													687.96	33		33					687.96	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	8	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.16	5.00		15.00					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				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	8	5	Specialty Tier	3	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													687.96	33		33					687.96	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	8	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					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				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	6	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					1.12	35.00		105.00					1.12	35.00		105.00																		40.00				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	6	4	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					2.58	80.00		240.00					2.58	80.00		240.00																		85.00				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	6	5	Specialty Tier	1	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													664.69	33		33					664.69	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	6	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.16	5.00		15.00					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				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	6	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					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				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	6	5	Specialty Tier	3	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													664.69	33		33					664.69	33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1026	038	0	1	01	01	H1026_038_0	6	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					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				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	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.16	5.00		15.00					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				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	5	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					1.29	40.00		120.00					1.29	40.00		120.00																		45.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	5	4	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					2.90	90.00		270.00					2.90	90.00		270.00																		95.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	5	5	Specialty Tier	1	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													677.22	33		33					677.22	33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.22	7.00		21.00					.06	2.00		6.00					.06	2.00		6.00																		7.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	040	0	1	01	01	H1026_040_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					.16	5.00		15.00					.16	5.00		15.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	040	0	1	01	01	H1026_040_0	5	5	Specialty Tier	3	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													677.22	33		33					677.22	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	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					.16	5.00		15.00					.16	5.00		15.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.22	7.00		21.00					.06	2.00		6.00					.06	2.00		6.00																		7.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	051	0	1	01	01	H1026_051_0	6	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					1.29	40.00		120.00					1.29	40.00		120.00																		45.00				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	6	4	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					2.90	90.00		270.00					2.90	90.00		270.00																		95.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	051	0	1	01	01	H1026_051_0	6	5	Specialty Tier	1	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													664.27	33		33					664.27	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	6	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.22	7.00		21.00					.06	2.00		6.00					.06	2.00		6.00																		7.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	051	0	1	01	01	H1026_051_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					.16	5.00		15.00					.16	5.00		15.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	051	0	1	01	01	H1026_051_0	6	5	Specialty Tier	3	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													664.27	33		33					664.27	33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1026	051	0	1	01	01	H1026_051_0	6	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					.16	5.00		15.00					.16	5.00		15.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	051	0	1	01	01	H1026_051_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.22	7.00		21.00					.06	2.00		6.00					.06	2.00		6.00																		7.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	055	0	1	01	01	H1026_055_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		120.00					1.13	35.00		105.00					1.13	35.00		105.00																		40.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	055	0	1	01	01	H1026_055_0	5	4	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					2.58	80.00		240.00					2.58	80.00		240.00																		85.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	055	0	1	01	01	H1026_055_0	5	5	Specialty Tier	1	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													694.20	33		33					694.20	33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	055	0	1	01	01	H1026_055_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.16	5.00		15.00					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	055	0	1	01	01	H1026_055_0	5	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					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	055	0	1	01	01	H1026_055_0	5	5	Specialty Tier	3	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													694.20	33		33					694.20	33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1026	055	0	1	01	01	H1026_055_0	5	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					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	055	0	1	01	01	H1026_055_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.16	5.00		15.00					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	5	5	Specialty Tier	3	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													698.97	33		33					698.97	33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1026	056	0	1	01	01	H1026_056_0	5	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					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	056	0	1	01	01	H1026_056_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.16	5.00		15.00					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	056	0	1	01	01	H1026_056_0	5	5	Specialty Tier	1	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													698.97	33		33					698.97	33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	5	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					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_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		120.00					1.13	35.00		105.00					1.13	35.00		105.00																		40.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	5	4	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					2.58	80.00		240.00					2.58	80.00		240.00																		85.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.16	5.00		15.00					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.16	5.00		15.00					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	057	0	1	01	01	H1026_057_0	5	5	Specialty Tier	1	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													698.97	33		33					698.97	33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	5	4	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					2.58	80.00		240.00					2.58	80.00		240.00																		85.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_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		120.00					1.13	35.00		105.00					1.13	35.00		105.00																		40.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	5	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					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.16	5.00		15.00					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	5	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					0.00	0.00		0.00					0.00	0.00		0.00																		5.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	057	0	1	01	01	H1026_057_0	5	5	Specialty Tier	3	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													698.97	33		33					698.97	33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1032	002	0	1	02	01	H1032_002_0	5	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				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	5	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.53	16.00		48.00					.33	10.00		30.00												0.53	16.00		48.00				.33	10.00		25.00				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	5	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.16	35.00		105.00					.83	25.00		75.00												1.16	35.00		105.00				.83	25.00		62.50				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	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														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	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									2.50	75.00		225.00					2.00	60.00		180.00												2.50	75.00		225.00				2.00	60.00		150.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	025	0	1	02	01	H1032_025_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		135.00					1.16	35.00		105.00												1.50	45.00		135.00				1.16	35.00		87.50				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	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.53	16.00		48.00					.33	10.00		30.00												.53	16.00		48.00				.33	10.00		25.00				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	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	6	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					2.50	75.00		225.00												3.00	90.00		270.00				2.50	75.00		187.50				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	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.16	5.00		15.00					.06	2.00		6.00												.16	5.00		15.00				.06	2.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	02	01	H1032_032_0	6	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					2.50	75.00		225.00												3.00	90.00		270.00				2.50	75.00		187.50				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	02	01	H1032_032_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					1.00	30.00		90.00												1.33	40.00		120.00				1.00	30.00		75.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	02	01	H1032_032_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				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	02	01	H1032_032_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.46	14.00		42.00					.20	6.00		18.00												.46	14.00		42.00				.20	6.00		15.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	02	01	H1032_032_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									2.33	70.00		210.00					1.83	55.00		165.00												2.33	70.00		210.00				1.83	55.00		137.50				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	6	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.00	30.00		90.00					.66	20.00		60.00												1.00	30.00		90.00				.66	20.00		50.00				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	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				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	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.53	16.00		48.00					.33	10.00		30.00												.53	16.00		48.00				.33	10.00		25.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	040	0	1	02	01	H1032_040_0	6	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.16	35.00		105.00					.83	25.00		75.00												1.16	35.00		105.00				0.83	25.00		62.50				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	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.53	16.00		48.00					.33	10.00		30.00												.53	16.00		48.00				.33	10.00		25.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	040	0	1	02	01	H1032_040_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									2.13	64.00		192.00					1.63	49.00		147.00												2.13	64.00		192.00				1.63	49.00		122.50				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	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				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	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		99.00					0.36	11.00		33.00												1.10	33.00		99.00				0.36	11.00		27.50				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	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					0.00	0.00		0.00												0.00	0.00		0.00				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	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.13	94.00		282.00					2.63	79.00		237.00												3.13	94.00		282.00				2.63	79.00		197.50				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	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					1.16	35.00		105.00												1.50	45.00		135.00				1.16	35.00		87.50				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	4	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				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	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.53	16.00		48.00					.33	10.00		30.00												.53	16.00		48.00				.33	10.00		25.00				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	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.53	16.00		48.00					.33	10.00		30.00												0.53	16.00		48.00				.33	10.00		25.00				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	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					1.16	35.00		105.00												1.50	45.00		135.00				1.16	35.00		87.50				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	4	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.13	94.00		282.00					2.63	79.00		237.00												3.13	94.00		282.00				2.63	79.00		197.50				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	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					.06	2.00		6.00												0.16	5.00		15.00				0.06	2.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	01	01	H1032_091_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									2.50	75.00		225.00					2.00	60.00		180.00												2.50	75.00		225.00				2.00	60.00		150.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	01	01	H1032_091_0	4	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				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	01	01	H1032_091_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.53	16.00		48.00					.33	10.00		30.00												.53	16.00		48.00				.33	10.00		25.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	01	01	H1032_091_0	4	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.16	35.00		105.00					0.83	25.00		75.00												1.16	35.00		105.00				0.83	25.00		62.50				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	01	01	H1032_091_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	8	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	8	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	8	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					0.00	0.00		0.00												0.00	0.00		0.00				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	8	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					.46	14.00		42.00												1.10	33.00		99.00				.46	14.00		35.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	8	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.53	16.00		48.00					.33	10.00		30.00												.53	16.00		48.00				.33	10.00		25.00				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	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					1.16	35.00		105.00												1.50	45.00		135.00				1.16	35.00		87.50				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	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.13	94.00		282.00					2.63	79.00		237.00												3.13	94.00		282.00				2.63	79.00		197.50				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	7	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	7	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				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	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	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					0.00	0.00		0.00												0.00	0.00		0.00				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	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		99.00					.80	24.00		72.00												1.10	33.00		99.00				0.80	24.00		60.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														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	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									2.50	75.00		225.00					2.00	60.00		180.00												2.50	75.00		225.00				2.00	60.00		150.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	173	0	1	01	01	H1032_173_0	5	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.16	35.00		105.00					0.83	25.00		75.00												1.16	35.00		105.00				0.83	25.00		62.50				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	173	0	1	01	01	H1032_173_0	5	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.53	16.00		48.00					.33	10.00		30.00												.53	16.00		48.00				.33	10.00		25.00				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	5	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				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	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	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				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	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.53	16.00		48.00					.33	10.00		30.00												.53	16.00		48.00				.33	10.00		25.00				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	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.00	30.00		90.00					.66	20.00		60.00												1.00	30.00		90.00				.66	20.00		50.00				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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									2.50	75.00		225.00					2.00	60.00		180.00												2.50	75.00		225.00				2.00	60.00		150.00				75.00				2.41	75.00		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				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_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					0.00	0.00		0.00												0.00	0.00		0.00				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	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		99.00					.53	16.00		48.00												1.10	33.00		99.00				.53	16.00		40.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														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	8	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		99.00												1.10	33.00		99.00				1.10	33.00		82.50				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_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				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	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														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	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					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	177	0	1	01	01	H1032_177_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									2.50	75.00		225.00					2.00	60.00		180.00												2.50	75.00		225.00				2.00	60.00		150.00				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	4	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.16	35.00		105.00					0.83	25.00		75.00												1.16	35.00		105.00				0.83	25.00		62.50				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	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.53	16.00		48.00					.33	10.00		30.00												.53	16.00		48.00				.33	10.00		25.00				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	4	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				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	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	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					2.50	75.00		225.00												3.00	90.00		270.00				2.50	75.00		187.50				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	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					1.16	35.00		105.00												1.50	45.00		135.00				1.16	35.00		87.50				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	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.53	16.00		48.00					.33	10.00		30.00												0.53	16.00		48.00				.33	10.00		25.00				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	4	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.20	6.00		18.00					0.10	3.00		9.00												0.20	6.00		18.00				0.10	3.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	180	0	1	01	01	H1032_180_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	180	0	1	01	01	H1032_180_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									1.00	30.00		90.00					.33	10.00		30.00												1.00	30.00		90.00				.33	10.00		25.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	180	0	1	01	01	H1032_180_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		135.00					1.00	30.00		90.00												1.50	45.00		135.00				1.00	30.00		75.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	180	0	1	01	01	H1032_180_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.50	75.00		225.00												3.16	95.00		285.00				2.50	75.00		187.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	180	0	1	01	01	H1032_180_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	181	0	1	02	01	H1032_181_0	6	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.10	3.00		9.00					.03	1.00		3.00												.10	3.00		9.00				.03	1.00		0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	181	0	1	02	01	H1032_181_0	6	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.50	15.00		45.00					.10	3.00		9.00												.50	15.00		45.00				.10	3.00		7.50				15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	181	0	1	02	01	H1032_181_0	6	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.50	75.00		225.00												3.16	95.00		285.00				2.50	75.00		187.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	181	0	1	02	01	H1032_181_0	6	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.13	34.00		102.00												1.50	45.00		135.00				1.13	34.00		85.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	181	0	1	02	01	H1032_181_0	6	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	12	5	Specialty Tier	1	4	010010	1	1		010	01			1				31										31		31													830.87	33							748.95	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	12	4	Non-Preferred Brand	1	4	100000	1	1		110	01	100		1				31		93	1			93				31		31													96.01	50		50					94.79	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	12	3	Preferred Brand	1	4	000001	1	1		110	01	100		1				31		93	1			93				31		31													34.89	25		25					34.38	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	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				31		93	1			93				31		31									.55	17.00		51.00					.13	4.00		12.00								9.00																		17.00				.55	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	002	0	1	02	01	H1035_002_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		93	1			93				31		31									.32	10.00		30.00					0.00	0.00		0.00								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	12	6	Injectable Drugs	1	4	010010	1	1		110	01	100		1				31		93	1			93				31		31													2.90	25		25					36.45	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	12	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				31		93	1			93				31		31									.32	10.00		30.00					0.00	0.00		0.00								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	12	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				31		93	1			93				31		31									.55	17.00		51.00					.13	4.00		12.00								9.00																		17.00				.55	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs										1		
H1035	006	0	1	01	01	H1035_006_0	9	5	Specialty Tier	1	4	010010	1	1		010	01			1				31										31		31													660.87	29							660.87	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	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				31		93	1			93				31		31									3.06	95.00		285.00					2.58	80.00		240.00								237.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	006	0	1	01	01	H1035_006_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				31		93	1			93				31		31									1.45	45.00		135.00					1.29	40.00		120.00								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	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				31		93	1			93				31		31									.55	17.00		51.00					.23	7.00		21.00								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	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		93	1			93				31		31									.32	10.00		30.00					.06	2.00		6.00								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	9	6	Injectable Drugs	1	4	010010	1	1		110	01	100		1				31		93	1			93				31		31													81.99	25		25					42.10	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	010	0	1	01	01	H1035_010_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		93	1			93				31		31									.32	10.00		30.00					.06	2.00		6.00								3.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	010	0	1	01	01	H1035_010_0	9	6	Injectable Drugs	1	4	010010	1	1		110	01	100		1				31		93	1			93				31		31													39.05	25		25					36.43	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	010	0	1	01	01	H1035_010_0	9	5	Specialty Tier	1	4	010010	1	1		010	01			1				31										31		31													832.87	33							749.88	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	010	0	1	01	01	H1035_010_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				31		93	1			93				31		31									3.06	95.00		285.00					2.58	80.00		240.00								237.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	010	0	1	01	01	H1035_010_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				31		93	1			93				31		31									1.45	45.00		135.00					1.29	40.00		120.00								117.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	010	0	1	01	01	H1035_010_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				31		93	1			93				31		31									.55	17.00		51.00					.23	7.00		21.00								18.00																		17.00				.55	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	011	0	1	02	01	H1035_011_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				31		93	1			93				31		31									.32	10.00		30.00					0.00	0.00		0.00								0.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs										1		
H1035	011	0	1	02	01	H1035_011_0	10	6	Injectable Drugs	1	4	010010	1	1		110	01	100		1				31		93	1			93				31		31													39.05	25		25					36.44	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	011	0	1	02	01	H1035_011_0	10	5	Specialty Tier	1	4	010010	1	1		010	01			1				31										31		31													832.65	33							749.59	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	011	0	1	02	01	H1035_011_0	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				31		93	1			93				31		31									3.06	95.00		285.00					2.58	80.00		240.00								237.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	011	0	1	02	01	H1035_011_0	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				31		93	1			93				31		31									1.45	45.00		135.00					1.29	40.00		120.00								117.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	011	0	1	02	01	H1035_011_0	10	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				31		93	1			93				31		31									.55	17.00		51.00					.13	7.00		21.00								18.00																		17.00				.55	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	011	0	1	02	01	H1035_011_0	10	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				31		93	1			93				31		31									.55	17.00		51.00					.13	7.00		21.00								18.00																		17.00				.55	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs										1		
H1035	011	0	1	02	01	H1035_011_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		93	1			93				31		31									.32	10.00		30.00					0.00	0.00		0.00								0.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1036	025	0	1	01	01	H1036_025_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	025	0	1	01	01	H1036_025_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	025	0	1	01	01	H1036_025_0	3	3	Preferred Brand	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		45.00				0.50	15.00		35.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_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		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												
H1036	025	0	1	01	01	H1036_025_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		3
H1036	025	0	1	01	01	H1036_025_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		
H1036	025	0	1	01	01	H1036_025_0	3	3	Preferred Brand	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		45.00				0.50	15.00		35.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	025	0	1	01	01	H1036_025_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		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										2	3	
H1036	025	0	1	01	01	H1036_025_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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	040	0	1	01	01	H1036_040_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	040	0	1	01	01	H1036_040_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	3	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		165.00				1.83	55.00		155.00				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	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		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										2	3	
H1036	040	0	1	01	01	H1036_040_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		
H1036	040	0	1	01	01	H1036_040_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		3
H1036	040	0	1	01	01	H1036_040_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	3	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		165.00				1.83	55.00		155.00				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	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		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												
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	2.83	85.00		255.00																												2.83	85.00		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										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	1.50	45.00		135.00																												1.50	45.00		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										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						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						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	2.83	85.00		255.00																												2.83	85.00		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												
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	1.50	45.00		135.00																												1.50	45.00		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												
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	
H1036	052	0	1	01	01	H1036_052_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	052	0	1	01	01	H1036_052_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	052	0	1	01	01	H1036_052_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H1036	052	0	1	01	01	H1036_052_0	3	3	Preferred Brand	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		45.00				0.50	15.00		35.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	052	0	1	01	01	H1036_052_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		
H1036	052	0	1	01	01	H1036_052_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		3
H1036	052	0	1	01	01	H1036_052_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1036	052	0	1	01	01	H1036_052_0	3	3	Preferred Brand	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		45.00				0.50	15.00		35.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_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	054	0	1	01	01	H1036_054_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		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										2	3	
H1036	054	0	1	01	01	H1036_054_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		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										2	3	
H1036	054	0	1	01	01	H1036_054_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	054	0	1	01	01	H1036_054_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1036	054	0	1	01	01	H1036_054_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		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												
H1036	054	0	1	01	01	H1036_054_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	054	0	1	01	01	H1036_054_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		3
H1036	062	0	1	01	01	H1036_062_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	062	0	1	01	01	H1036_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												
H1036	062	0	1	01	01	H1036_062_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H1036	062	0	1	01	01	H1036_062_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		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										2	3	
H1036	062	0	1	01	01	H1036_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		
H1036	062	0	1	01	01	H1036_062_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		3
H1036	062	0	1	01	01	H1036_062_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_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		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												
H1036	062	0	1	01	01	H1036_062_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		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												
H1036	065	0	1	01	01	H1036_065_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	065	0	1	01	01	H1036_065_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		150.00				1.66	50.00		140.00				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	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		60.00				0.66	20.00		50.00				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	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	065	0	1	01	01	H1036_065_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		150.00				1.66	50.00		140.00				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	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		60.00				0.66	20.00		50.00				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	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	065	0	1	01	01	H1036_065_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		3
H1036	067	0	1	01	01	H1036_067_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		3
H1036	067	0	1	01	01	H1036_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										1		
H1036	067	0	1	01	01	H1036_067_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		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										2	3	
H1036	067	0	1	01	01	H1036_067_0	3	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		165.00				1.83	55.00		155.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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	067	0	1	01	01	H1036_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												
H1036	067	0	1	01	01	H1036_067_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		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												
H1036	067	0	1	01	01	H1036_067_0	3	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		165.00				1.83	55.00		155.00				55.00				1.77	55.00		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	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	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		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		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												
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		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												
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		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										2	3	
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	
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	0.23	7.00		21.00																												0.23	7.00		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	068	0	1	01	01	H1036_068_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
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						33																														33							33					33				33	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	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	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
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	0.50	15.00		45.00																												0.50	15.00		45.00				0.50	15.00		35.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	074	0	1	01	01	H1036_074_0	4	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		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						33																														33							33					33				33	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		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												
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	0.50	15.00		45.00																												0.50	15.00		45.00				0.50	15.00		35.00				15.00				0.48	15.00		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	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	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	077	0	1	01	01	H1036_077_0	5	5	Specialty Tier	1	4	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												
H1036	077	0	1	01	01	H1036_077_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		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												
H1036	077	0	1	01	01	H1036_077_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		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												
H1036	077	0	1	01	01	H1036_077_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	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	0.23	7.00		21.00																												0.23	7.00		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	081	0	1	01	01	H1036_081_0	3	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	
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		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										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						33																														33							33					33				33	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	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		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										2	3	
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	0.23	7.00		21.00																												0.23	7.00		21.00				0.23	7.00		0.00				7.00				0.22	7.00		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		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												
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						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	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		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												
H1036	102	0	1	01	01	H1036_102_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_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	102	0	1	01	01	H1036_102_0	6	5	Specialty Tier	1	4	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												
H1036	102	0	1	01	01	H1036_102_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		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												
H1036	102	0	1	01	01	H1036_102_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		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												
H1036	103	0	1	01	01	H1036_103_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	103	0	1	01	01	H1036_103_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	103	0	1	01	01	H1036_103_0	5	5	Specialty Tier	1	4	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												
H1036	103	0	1	01	01	H1036_103_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		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												
H1036	103	0	1	01	01	H1036_103_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		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												
H1036	104	0	1	01	01	H1036_104_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	104	0	1	01	01	H1036_104_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		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												
H1036	104	0	1	01	01	H1036_104_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		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												
H1036	104	0	1	01	01	H1036_104_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	104	0	1	01	01	H1036_104_0	3	5	Specialty Tier	1	4	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												
H1036	121	0	1	01	01	H1036_121_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		
H1036	121	0	1	01	01	H1036_121_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		3
H1036	121	0	1	01	01	H1036_121_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		150.00				1.66	50.00		140.00				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	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		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												
H1036	121	0	1	01	01	H1036_121_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	121	0	1	01	01	H1036_121_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	121	0	1	01	01	H1036_121_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		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										2	3	
H1036	121	0	1	01	01	H1036_121_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		150.00				1.66	50.00		140.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	130	0	1	01	01	H1036_130_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	130	0	1	01	01	H1036_130_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	130	0	1	01	01	H1036_130_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H1036	130	0	1	01	01	H1036_130_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		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										2	3	
H1036	130	0	1	01	01	H1036_130_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		
H1036	130	0	1	01	01	H1036_130_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		3
H1036	130	0	1	01	01	H1036_130_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1036	130	0	1	01	01	H1036_130_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		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												
H1036	137	0	1	01	01	H1036_137_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_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		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										2	3	
H1036	137	0	1	01	01	H1036_137_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		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										2	3	
H1036	137	0	1	01	01	H1036_137_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	137	0	1	01	01	H1036_137_0	3	5	Specialty Tier	3	4	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										2	3	
H1036	137	0	1	01	01	H1036_137_0	3	5	Specialty Tier	1	4	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												
H1036	137	0	1	01	01	H1036_137_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		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												
H1036	137	0	1	01	01	H1036_137_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		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												
H1036	137	0	1	01	01	H1036_137_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	138	0	1	01	01	H1036_138_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		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										2	3	
H1036	138	0	1	01	01	H1036_138_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		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										2	3	
H1036	138	0	1	01	01	H1036_138_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	138	0	1	01	01	H1036_138_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		15.00				0.16	5.00		0.00				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	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_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		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												
H1036	138	0	1	01	01	H1036_138_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		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												
H1036	138	0	1	01	01	H1036_138_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	138	0	1	01	01	H1036_138_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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	140	0	1	01	01	H1036_140_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	140	0	1	01	01	H1036_140_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H1036	140	0	1	01	01	H1036_140_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		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										2	3	
H1036	140	0	1	01	01	H1036_140_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	140	0	1	01	01	H1036_140_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	
H1036	140	0	1	01	01	H1036_140_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1036	140	0	1	01	01	H1036_140_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		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												
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	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		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										2	3	
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	1.50	45.00		135.00																												1.50	45.00		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										2	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	0.33	10.00		30.00																												0.33	10.00		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	141	0	1	01	01	H1036_141_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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						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	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		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												
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	1.50	45.00		135.00																												1.50	45.00		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												
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	0.33	10.00		30.00																												0.33	10.00		30.00				0.33	10.00		0.00				10.00				0.32	10.00		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	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	0.33	10.00		30.00																												0.33	10.00		30.00				0.33	10.00		0.00				10.00				0.32	10.00		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	1.50	45.00		135.00																												1.50	45.00		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												
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	2.83	85.00		255.00																												2.83	85.00		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												
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						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	
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	0.33	10.00		30.00																												0.33	10.00		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	143	0	1	01	01	H1036_143_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		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										2	3	
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	2.83	85.00		255.00																												2.83	85.00		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										2	3	
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						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	146	0	1	01	01	H1036_146_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	146	0	1	01	01	H1036_146_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_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		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												
H1036	146	0	1	01	01	H1036_146_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		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												
H1036	146	0	1	01	01	H1036_146_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		
H1036	146	0	1	01	01	H1036_146_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	146	0	1	01	01	H1036_146_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		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										2	3	
H1036	146	0	1	01	01	H1036_146_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		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										2	3	
H1036	146	0	1	01	01	H1036_146_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	3	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		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												
H1036	151	0	1	01	01	H1036_151_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		36.00				0.40	12.00		0.00				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	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		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												
H1036	151	0	1	01	01	H1036_151_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		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												
H1036	151	0	1	01	01	H1036_151_0	3	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		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										2	3	
H1036	151	0	1	01	01	H1036_151_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	151	0	1	01	01	H1036_151_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		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										2	3	
H1036	151	0	1	01	01	H1036_151_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		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										2	3	
H1036	151	0	1	01	01	H1036_151_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	151	0	1	01	01	H1036_151_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	3	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		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												
H1036	153	0	1	01	01	H1036_153_0	3	5	Specialty Tier	3	4	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										2	3	
H1036	153	0	1	01	01	H1036_153_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		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										2	3	
H1036	153	0	1	01	01	H1036_153_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		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										2	3	
H1036	153	0	1	01	01	H1036_153_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	153	0	1	01	01	H1036_153_0	3	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		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										2	3	
H1036	153	0	1	01	01	H1036_153_0	3	5	Specialty Tier	1	4	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												
H1036	153	0	1	01	01	H1036_153_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		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												
H1036	153	0	1	01	01	H1036_153_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		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												
H1036	153	0	1	01	01	H1036_153_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	156	0	1	01	01	H1036_156_0	5	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
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	1.50	45.00		135.00																												1.50	45.00		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 Care Drugs												
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, Select Care Drugs												
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, Select Care Drugs												
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						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	1	
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	2.83	85.00		255.00																												2.83	85.00		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, Select Care Drugs										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	1.50	45.00		135.00																												1.50	45.00		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 Care Drugs										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, Select Care Drugs										2	2	
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, Select Care Drugs										2	3	3
H1036	156	0	1	01	01	H1036_156_0	5	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	2.83	85.00		255.00																												2.83	85.00		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, Select Care Drugs												
H1036	157	0	1	01	01	H1036_157_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		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										2	3	
H1036	157	0	1	01	01	H1036_157_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		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										2	3	
H1036	157	0	1	01	01	H1036_157_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	157	0	1	01	01	H1036_157_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	157	0	1	01	01	H1036_157_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		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												
H1036	157	0	1	01	01	H1036_157_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	157	0	1	01	01	H1036_157_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		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												
H1036	160	0	1	01	01	H1036_160_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		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, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_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		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, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_0	3	3	Preferred Brand	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		45.00				0.50	15.00		35.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_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, Select Care Drugs										2	2	
H1036	160	0	1	01	01	H1036_160_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, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_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, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3	3	Preferred Brand	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		45.00				0.50	15.00		35.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1036	160	0	1	01	01	H1036_160_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_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, Select Care Drugs										2	3	3
H1036	167	0	1	01	01	H1036_167_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	167	0	1	01	01	H1036_167_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		30.00				0.33	10.00		0.00				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	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		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												
H1036	167	0	1	01	01	H1036_167_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		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												
H1036	167	0	1	01	01	H1036_167_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_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		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												
H1036	168	0	1	01	01	H1036_168_0	7	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	7	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		132.00				1.46	44.00		122.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	7	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		30.00				0.33	10.00		0.00				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	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												
H1036	169	0	1	01	01	H1036_169_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												
H1036	169	0	1	01	01	H1036_169_0	4	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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	169	0	1	01	01	H1036_169_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		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												
H1036	169	0	1	01	01	H1036_169_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		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												
H1036	169	0	1	01	01	H1036_169_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	170	0	1	01	01	H1036_170_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		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												
H1036	170	0	1	01	01	H1036_170_0	3	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	170	0	1	01	01	H1036_170_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	170	0	1	01	01	H1036_170_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	170	0	1	01	01	H1036_170_0	3	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		270.00				3.00	90.00		260.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	171	0	1	01	01	H1036_171_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		36.00				0.40	12.00		0.00				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	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		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										2	3	
H1036	171	0	1	01	01	H1036_171_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_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		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												
H1036	171	0	1	01	01	H1036_171_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		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												
H1036	171	0	1	01	01	H1036_171_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		36.00				0.40	12.00		0.00				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	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		15.00				0.16	5.00		0.00				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	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		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										2	3	
H1036	171	0	1	01	01	H1036_171_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	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	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, Select Care Drugs												
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	0.23	7.00		21.00																												0.23	7.00		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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		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 Care Drugs												
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		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, Select Care Drugs												
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						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	3	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1036	175	0	1	01	01	H1036_175_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, Select Care Drugs										2	3	3
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	0.23	7.00		21.00																												0.23	7.00		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										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		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 Care Drugs										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		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, Select Care Drugs										2	3	
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						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	3	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	178	0	1	01	01	H1036_178_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	178	0	1	01	01	H1036_178_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	178	0	1	01	01	H1036_178_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		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 Care Drugs												
H1036	178	0	1	01	01	H1036_178_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		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, Select Care Drugs												
H1036	178	0	1	01	01	H1036_178_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	178	0	1	01	01	H1036_178_0	3	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	178	0	1	01	01	H1036_178_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	178	0	1	01	01	H1036_178_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	178	0	1	01	01	H1036_178_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		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 Care Drugs										2	3	
H1036	178	0	1	01	01	H1036_178_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		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, Select Care Drugs										2	3	
H1036	178	0	1	01	01	H1036_178_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	178	0	1	01	01	H1036_178_0	3	6	Select Care Drugs	3	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1036	179	0	1	01	01	H1036_179_0	3	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		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 Care Drugs												
H1036	179	0	1	01	01	H1036_179_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	179	0	1	01	01	H1036_179_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		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 Care Drugs												
H1036	179	0	1	01	01	H1036_179_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		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, Select Care Drugs												
H1036	179	0	1	01	01	H1036_179_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	179	0	1	01	01	H1036_179_0	3	6	Select Care Drugs	3	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		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 Care Drugs										1		
H1036	179	0	1	01	01	H1036_179_0	3	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		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 Care Drugs										2	3	
H1036	179	0	1	01	01	H1036_179_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	179	0	1	01	01	H1036_179_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		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 Care Drugs										2	3	
H1036	179	0	1	01	01	H1036_179_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		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, Select Care Drugs										2	3	
H1036	179	0	1	01	01	H1036_179_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	179	0	1	01	01	H1036_179_0	3	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		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 Care Drugs												
H1036	184	0	1	01	01	H1036_184_0	4	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	184	0	1	01	01	H1036_184_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	184	0	1	01	01	H1036_184_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		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 Care Drugs												
H1036	184	0	1	01	01	H1036_184_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		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, Select Care Drugs												
H1036	184	0	1	01	01	H1036_184_0	4	5	Specialty Tier	1	4	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, Select Care Drugs												
H1036	184	0	1	01	01	H1036_184_0	4	5	Specialty Tier	3	4	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, Select Care Drugs										2	3	
H1036	184	0	1	01	01	H1036_184_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	184	0	1	01	01	H1036_184_0	4	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	184	0	1	01	01	H1036_184_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		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 Care Drugs										2	3	
H1036	184	0	1	01	01	H1036_184_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		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, Select Care Drugs										2	3	
H1036	184	0	1	01	01	H1036_184_0	4	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	186	0	1	01	01	H1036_186_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	186	0	1	01	01	H1036_186_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	186	0	1	01	01	H1036_186_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		150.00				1.66	50.00		140.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H1036	186	0	1	01	01	H1036_186_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	186	0	1	01	01	H1036_186_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	
H1036	186	0	1	01	01	H1036_186_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		150.00				1.66	50.00		140.00				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	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		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												
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	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										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		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										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		3
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						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	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		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												
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		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												
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	189	0	1	01	01	H1036_189_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		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												
H1036	189	0	1	01	01	H1036_189_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		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												
H1036	189	0	1	01	01	H1036_189_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		
H1036	189	0	1	01	01	H1036_189_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		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										2	3	
H1036	189	0	1	01	01	H1036_189_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		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										2	3	
H1036	189	0	1	01	01	H1036_189_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												
H1036	189	0	1	01	01	H1036_189_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	189	0	1	01	01	H1036_189_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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	190	0	1	01	01	H1036_190_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		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												
H1036	190	0	1	01	01	H1036_190_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		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												
H1036	190	0	1	01	01	H1036_190_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	
H1036	190	0	1	01	01	H1036_190_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	190	0	1	01	01	H1036_190_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		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										2	3	
H1036	190	0	1	01	01	H1036_190_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		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										2	3	
H1036	190	0	1	01	01	H1036_190_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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	190	0	1	01	01	H1036_190_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	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		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, Select Care Drugs												
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, Select Care Drugs												
H1036	193	0	1	01	01	H1036_193_0	3	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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, Select Care Drugs										2	3	3
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	0.33	10.00		30.00																												0.33	10.00		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										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	1.16	35.00		105.00																												1.16	35.00		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 Care Drugs										2	3	
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		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, Select Care Drugs										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						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	193	0	1	01	01	H1036_193_0	3	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
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						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	0.33	10.00		30.00																												0.33	10.00		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	1.16	35.00		105.00																												1.16	35.00		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 Care Drugs												
H1036	194	0	1	01	01	H1036_194_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		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, Select Care Drugs												
H1036	194	0	1	01	01	H1036_194_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, Select Care Drugs												
H1036	194	0	1	01	01	H1036_194_0	3	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	194	0	1	01	01	H1036_194_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, Select Care Drugs										2	3	3
H1036	194	0	1	01	01	H1036_194_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	194	0	1	01	01	H1036_194_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		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 Care Drugs										2	3	
H1036	194	0	1	01	01	H1036_194_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		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, Select Care Drugs										2	3	
H1036	194	0	1	01	01	H1036_194_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	194	0	1	01	01	H1036_194_0	3	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1036	194	0	1	01	01	H1036_194_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	194	0	1	01	01	H1036_194_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	194	0	1	01	01	H1036_194_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		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 Care Drugs												
H1036	196	0	1	01	01	H1036_196_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		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												
H1036	196	0	1	01	01	H1036_196_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	196	0	1	01	01	H1036_196_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	
H1036	196	0	1	01	01	H1036_196_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		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	196	0	1	01	01	H1036_196_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		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										2	3	
H1036	196	0	1	01	01	H1036_196_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		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										2	3	
H1036	196	0	1	01	01	H1036_196_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_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		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												
H1036	199	0	1	01	01	H1036_199_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		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												
H1036	199	0	1	01	01	H1036_199_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	199	0	1	01	01	H1036_199_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	199	0	1	01	01	H1036_199_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_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		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										2	3	
H1036	199	0	1	01	01	H1036_199_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1036	199	0	1	01	01	H1036_199_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_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		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										2	3	
H1036	209	0	1	01	01	H1036_209_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												
H1036	209	0	1	01	01	H1036_209_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		33.00				0.36	11.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_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		132.00				1.46	44.00		122.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_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		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												
H1036	209	0	1	01	01	H1036_209_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						26																														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_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												
H1036	210	0	1	01	01	H1036_210_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_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		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												
H1036	210	0	1	01	01	H1036_210_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		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												
H1036	210	0	1	01	01	H1036_210_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_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												
H1036	213	0	1	01	01	H1036_213_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_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		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												
H1036	213	0	1	01	01	H1036_213_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		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												
H1036	213	0	1	01	01	H1036_213_0	5	5	Specialty Tier	1	4	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												
H1036	214	0	1	01	01	H1036_214_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		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												
H1036	214	0	1	01	01	H1036_214_0	4	5	Specialty Tier	1	3	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												
H1036	214	0	1	01	01	H1036_214_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												
H1036	214	0	1	01	01	H1036_214_0	4	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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_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		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												
H1036	215	0	1	01	01	H1036_215_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	
H1036	215	0	1	01	01	H1036_215_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	215	0	1	01	01	H1036_215_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		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										2	3	
H1036	215	0	1	01	01	H1036_215_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		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										2	3	
H1036	215	0	1	01	01	H1036_215_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_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		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												
H1036	215	0	1	01	01	H1036_215_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		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												
H1036	215	0	1	01	01	H1036_215_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_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	217	0	1	01	01	H1036_217_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		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	217	0	1	01	01	H1036_217_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	
H1036	217	0	1	01	01	H1036_217_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1036	217	0	1	01	01	H1036_217_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		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												
H1036	217	0	1	01	01	H1036_217_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		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_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												
H1036	217	0	1	01	01	H1036_217_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		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										2	3	
H1036	217	0	1	01	01	H1036_217_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	217	0	1	01	01	H1036_217_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		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										2	3	
H1036	218	0	1	01	01	H1036_218_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	218	0	1	01	01	H1036_218_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		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H1036	218	0	1	01	01	H1036_218_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		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										2	3	
H1036	218	0	1	01	01	H1036_218_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		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	218	0	1	01	01	H1036_218_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	
H1036	218	0	1	01	01	H1036_218_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_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		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												
H1036	218	0	1	01	01	H1036_218_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		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												
H1036	219	0	1	01	01	H1036_219_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_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		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										2	3	
H1036	219	0	1	01	01	H1036_219_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		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										2	3	
H1036	219	0	1	01	01	H1036_219_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	219	0	1	01	01	H1036_219_0	3	5	Specialty Tier	3	4	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										2	3	
H1036	219	0	1	01	01	H1036_219_0	3	5	Specialty Tier	1	4	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												
H1036	219	0	1	01	01	H1036_219_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		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												
H1036	219	0	1	01	01	H1036_219_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		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												
H1036	219	0	1	01	01	H1036_219_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	222	0	1	01	01	H1036_222_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	222	0	1	01	01	H1036_222_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_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		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												
H1036	222	0	1	01	01	H1036_222_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		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												
H1036	222	0	1	01	01	H1036_222_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	223	0	1	01	01	H1036_223_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	223	0	1	01	01	H1036_223_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		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										2	3	
H1036	223	0	1	01	01	H1036_223_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		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										2	3	
H1036	223	0	1	01	01	H1036_223_0	3	5	Specialty Tier	1	4	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												
H1036	223	0	1	01	01	H1036_223_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		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												
H1036	223	0	1	01	01	H1036_223_0	3	5	Specialty Tier	3	4	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										2	3	
H1036	223	0	1	01	01	H1036_223_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_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		15.00				0.16	5.00		0.00				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	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		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												
H1036	226	0	1	01	01	H1036_226_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		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												
H1036	226	0	1	01	01	H1036_226_0	6	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		126.00				1.40	42.00		116.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	6	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		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												
H1036	226	0	1	01	01	H1036_226_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	226	0	1	01	01	H1036_226_0	6	5	Specialty Tier	1	3	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												
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	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		60.00				0.66	20.00		0.00				20.00				0.64	20.00		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						30																														30							30					30				30	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	3.16	95.00		285.00																												3.16	95.00		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										2	3	
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	1.50	45.00		135.00																												1.50	45.00		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										2	3	
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	0.66	20.00		60.00																												0.66	20.00		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	227	0	1	01	01	H1036_227_0	3	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	
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						30																														30							30					30				30	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	3.16	95.00		285.00																												3.16	95.00		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												
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	1.50	45.00		135.00																												1.50	45.00		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												
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	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		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										2	3	
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	1.50	45.00		135.00																												1.50	45.00		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										2	3	
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	0.66	20.00		60.00																												0.66	20.00		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	229	0	1	01	01	H1036_229_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	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						30																														30							30					30				30	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	3.16	95.00		285.00																												3.16	95.00		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												
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	1.50	45.00		135.00																												1.50	45.00		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												
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	0.66	20.00		60.00																												0.66	20.00		60.00				0.66	20.00		0.00				20.00				0.64	20.00		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	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	
H1036	230	0	1	01	01	H1036_230_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	230	0	1	01	01	H1036_230_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_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		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												
H1036	230	0	1	01	01	H1036_230_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		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												
H1036	230	0	1	01	01	H1036_230_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_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	
H1036	230	0	1	01	01	H1036_230_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	230	0	1	01	01	H1036_230_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		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										2	3	
H1036	230	0	1	01	01	H1036_230_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		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										2	3	
H1036	230	0	1	01	01	H1036_230_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	231	0	1	01	01	H1036_231_0	6	2	Non-Preferred Generic	1	3	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	231	0	1	01	01	H1036_231_0	6	5	Specialty Tier	1	3	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												
H1036	231	0	1	01	01	H1036_231_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		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												
H1036	231	0	1	01	01	H1036_231_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		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												
H1036	231	0	1	01	01	H1036_231_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	233	0	1	01	01	H1036_233_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		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										2	3	
H1036	233	0	1	01	01	H1036_233_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	233	0	1	01	01	H1036_233_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		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										2	3	
H1036	233	0	1	01	01	H1036_233_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	233	0	1	01	01	H1036_233_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		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												
H1036	233	0	1	01	01	H1036_233_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		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												
H1036	233	0	1	01	01	H1036_233_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	233	0	1	01	01	H1036_233_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	
H1036	234	0	1	01	01	H1036_234_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	234	0	1	01	01	H1036_234_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		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, Select Care Drugs										2	3	
H1036	234	0	1	01	01	H1036_234_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		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 Care Drugs										2	3	
H1036	234	0	1	01	01	H1036_234_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, Select Care Drugs										2	3	
H1036	234	0	1	01	01	H1036_234_0	7	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_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		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, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_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		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 Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	7	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		42.00				0.46	14.00		0.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_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, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	7	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		42.00				0.46	14.00		0.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	235	0	1	01	01	H1036_235_0	6	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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_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		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												
H1036	235	0	1	01	01	H1036_235_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		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												
H1036	235	0	1	01	01	H1036_235_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	236	0	1	01	01	H1036_236_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	236	0	1	01	01	H1036_236_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		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												
H1036	236	0	1	01	01	H1036_236_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		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										2	3	
H1036	236	0	1	01	01	H1036_236_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	236	0	1	01	01	H1036_236_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	
H1036	236	0	1	01	01	H1036_236_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_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		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												
H1036	236	0	1	01	01	H1036_236_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		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										2	3	
H1036	236	0	1	01	01	H1036_236_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_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												
H1036	237	1	1	01	01	H1036_237_1	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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	237	1	1	01	01	H1036_237_1	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	
H1036	237	1	1	01	01	H1036_237_1	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	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		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												
H1036	237	1	1	01	01	H1036_237_1	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	237	1	1	01	01	H1036_237_1	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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	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												
H1036	237	1	1	01	01	H1036_237_1	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		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										2	3	
H1036	237	1	1	01	01	H1036_237_1	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		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										2	3	
H1036	237	1	1	01	01	H1036_237_1	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		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												
H1036	237	2	1	01	01	H1036_237_2	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												
H1036	237	2	1	01	01	H1036_237_2	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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	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		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												
H1036	237	2	1	01	01	H1036_237_2	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		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												
H1036	237	2	1	01	01	H1036_237_2	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	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	
H1036	237	2	1	01	01	H1036_237_2	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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	237	2	1	01	01	H1036_237_2	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		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										2	3	
H1036	237	2	1	01	01	H1036_237_2	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		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										2	3	
H1036	237	2	1	01	01	H1036_237_2	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1045	001	0	1	02	01	H1045_001_0	5	4	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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_0	5	1	Preferred Generic	3	4	001010	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		3
H1045	001	0	1	02	01	H1045_001_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																															75.00							65.00				25.00				.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_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	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_0	5	1	Preferred Generic	1	4	001010	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	005	0	1	01	01	H1045_005_0	4	2	Preferred Brand	1	4	010001	3	2	110		01		100	1	30		90				1						90	30		31	.66	20.00		60.00																															60.00							50.00				20.00				.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4	1	Preferred Generic	1	4	001010	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	005	0	1	01	01	H1045_005_0	4	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																															120.00							110.00				40.00				1.29	40.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4	1	Preferred Generic	3	4	001010	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		3
H1045	005	0	1	01	01	H1045_005_0	4	4	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					824.00	33		33																														33							33			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	012	0	1	02	01	H1045_012_0	4	1	Preferred Generic	1	4	001010	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	4	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	4	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					387.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	012	0	1	02	01	H1045_012_0	4	3	Non-Preferred Brand	1	4	100100	1	1	110		01	100		1	30		90				1			90				30		31					25.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	012	0	1	02	01	H1045_012_0	4	1	Preferred Generic	3	4	001010	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		3
H1045	016	0	1	01	01	H1045_016_0	4	1	Preferred Generic	3	4	001010	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		3
H1045	016	0	1	01	01	H1045_016_0	4	4	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					284.00	33		33																														33							33			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	016	0	1	01	01	H1045_016_0	4	3	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	.83	25.00		75.00																															75.00							65.00				25.00				.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	016	0	1	01	01	H1045_016_0	4	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	4	1	Preferred Generic	1	4	001010	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	4	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		3
H1045	018	0	1	01	01	H1045_018_0	4	3	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	.83	25.00		75.00																															75.00							65.00				25.00				.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	4	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	4	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		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	4	4	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					934.00	33		33																														33							33			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	4	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		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	018	0	1	01	01	H1045_018_0	4	2	Preferred Brand	3	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										1		
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																															285.00							275.00				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																															135.00							125.00				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	001010	1	2	110		01		100	1	30		90				1						90	30		31	.20	6.00		18.00																															18.00							12.00				6.00				.19	6.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					521.00	33		33																														33							33			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															9.00							6.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	2	2	Non-Preferred Generic	1	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	.23	7.00		21.00																															21.00							14.00				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	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	2	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																															285.00							275.00				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	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					663.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					647.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	004	0	1	01	01	H1080_004_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	004	0	1	01	01	H1080_004_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	004	0	1	01	01	H1080_004_0	2	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							125.00				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	2	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							275.00				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	2	5	Specialty Tier	1	3	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												
H1080	042	0	1	01	01	H1080_042_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	042	0	1	01	01	H1080_042_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	042	0	1	01	01	H1080_042_0	2	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							125.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					916.00	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	2	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							275.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	043	0	1	01	01	H1080_043_0	2	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																															27.00							18.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	043	0	1	01	01	H1080_043_0	2	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							275.00				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	2	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							125.00				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	2	5	Specialty Tier	1	3	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												
H1099	001	0	1	02	01	H1099_001_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																								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	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												
H1099	001	0	1	02	01	H1099_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																								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	5	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	5	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	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		
H1099	001	0	1	02	01	H1099_001_0	5	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	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												
H1099	006	0	1	01	01	H1099_006_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																								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	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																								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	5	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	5	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	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		
H1099	014	0	1	01	01	H1099_014_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	014	0	1	01	01	H1099_014_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												
H1099	014	0	1	01	01	H1099_014_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	014	0	1	01	01	H1099_014_0	6	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	6	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	02	01	H1099_016_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	2.00		6.00																								0.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1099	016	0	1	02	01	H1099_016_0	4	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	02	01	H1099_016_0	4	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																								180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	016	0	1	02	01	H1099_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																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	016	0	1	02	01	H1099_016_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		15.00																								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	016	0	1	02	01	H1099_016_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	2.00		6.00																								0.00																		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	5	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	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		
H1099	017	0	1	02	01	H1099_017_0	5	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																								180.00																		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	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																								90.00																		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	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.06	2.00		6.00																								0.00																		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	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.06	2.00		6.00																								0.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1099	017	0	1	02	01	H1099_017_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												
H1109	005	0	1	01	01	H1109_005_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00	20.00	30.00				0.13	4.00	8.00	12.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.43	13.00	26.00	39.00					0.23	7.00	14.00	21.00												0.43	13.00	26.00	39.00				0.23	7.00	14.00	21.00					13.00			0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_0	5	3	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	135.00												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												
H1109	005	0	1	01	01	H1109_005_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													45.65	50	50	50					42.84	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					756.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	2	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							275.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														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	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.46	74.00		222.00												3.16	95.00		285.00				2.46	74.00		185.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					.83	25.00		75.00												1.50	45.00		135.00				.83	25.00		62.50				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	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.46	14.00		42.00					.06	2.00		6.00												.46	14.00		42.00				.06	2.00		5.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	01	01	H1112_027_0	7	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	01	01	H1112_027_0	7	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.20	6.00		18.00					.10	3.00		9.00												.20	6.00		18.00				.10	3.00		0.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	01	01	H1112_027_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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	01	01	H1112_027_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.83	85.00		255.00												3.16	95.00		285.00				2.83	85.00		212.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	01	01	H1112_027_0	7	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					.33	10.00		30.00												1.10	33.00		99.00				.33	10.00		25.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1170	002	0	1	01	01	H1170_002_0	7	2	Non-Preferred Generic	3	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31									.66	20.00		60.00					.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	7	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	002	0	1	01	01	H1170_002_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				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	7	1	Preferred Generic	3	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.16	5.00		15.00												.33	10.00		30.00				.16	5.00		0.00				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	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					.16	5.00		15.00												.33	10.00		30.00				.16	5.00		0.00				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	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31									.66	20.00		60.00					.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	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					1.46	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	7	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					2.66	80.00		240.00												3.00	90.00		270.00				2.66	80.00		160.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	7	5	Specialty Tier	1	4	100001	1	1		110	01		110	1				30		90	2				30		90	30		31													1470.00	33		33					1470.00	33		33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	2				30		90	30		31									1.00	30.00		90.00					0.53	16.00		48.00												1.00	30.00		90.00				.53	16.00		32.00				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	7	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					1.46	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	7	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					2.83	85.00		255.00												3.00	90.00		180.00				2.83	85.00		170.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	7	5	Specialty Tier	1	3	100001	1	1		110	01		110	1				30		90	2				30		90	30		31													1217.00	33		33					1217.00	33		33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_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				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	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.16	5.00		15.00												.33	10.00		30.00				.16	5.00		0.00				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	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	009	0	1	01	01	H1170_009_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					.23	7.00		21.00												.33	10.00		30.00				.23	7.00		0.00				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	6	2	Non-Preferred Generic	3	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31									.66	20.00		60.00					.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	6	1	Preferred Generic	3	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.23	7.00		21.00												.33	10.00		30.00				.23	7.00		0.00				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	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	009	0	1	01	01	H1170_009_0	6	5	Specialty Tier	1	4	100001	1	1		110	01		110	1				30		90	2				30		90	30		31													1490.00	33		33					1490.00	33		33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_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		285.00												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, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31									.66	20.00		60.00					.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	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					1.46	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												
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	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	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					934.00	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	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	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												
H1230	003	0	1	01	01	H1230_003_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		
H1230	003	0	1	01	01	H1230_003_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		
H1230	003	0	1	01	01	H1230_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												
H1230	003	0	1	01	01	H1230_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		
H1230	003	0	1	01	01	H1230_003_0	5	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	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												
H1230	003	0	1	01	01	H1230_003_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												
H1230	003	0	1	01	01	H1230_003_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					726.00	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	2	Non-Preferred Generic	3	4	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										1		
H1230	005	0	1	01	01	H1230_005_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		
H1230	005	0	1	01	01	H1230_005_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, 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	4	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	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	005	0	1	01	01	H1230_005_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												
H1230	005	0	1	01	01	H1230_005_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					1009.00	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	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	005	0	1	01	01	H1230_005_0	5	1	Preferred Generic	3	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, Vaccines										1		
H1230	006	0	1	01	01	H1230_006_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												
H1230	006	0	1	01	01	H1230_006_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												
H1230	006	0	1	01	01	H1230_006_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												
H1230	006	0	1	01	01	H1230_006_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		
H1230	006	0	1	01	01	H1230_006_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					1000.00	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	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		
H1230	006	0	1	01	01	H1230_006_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		
H1230	006	0	1	01	01	H1230_006_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												
H1230	006	0	1	01	01	H1230_006_0	5	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												
H1264	004	0	1	02	01	H1264_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									1.00	30.00		90.00					0.33	10.00		30.00												1.00	30.00		90.00				0.33	10.00		25.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_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		135.00					1.00	30.00		90.00												1.50	45.00		135.00				1.00	30.00		75.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.50	75.00		225.00												3.16	95.00		285.00				2.50	75.00		187.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.33	10.00		30.00					0.10	3.00		9.00												0.33	10.00		30.00				0.10	3.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									1.00	30.00		90.00					0.06	2.00		6.00												1.00	30.00		90.00				0.06	2.00		5.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.50	75.00		225.00												3.16	95.00		285.00				2.50	75.00		187.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_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					1.00	30.00		90.00												1.50	45.00		135.00				1.00	30.00		75.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									1.00	30.00		90.00					0.33	10.00		30.00												1.00	30.00		90.00				0.33	10.00		25.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.33	10.00		30.00					0.10	3.00		9.00												0.33	10.00		30.00				0.10	3.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.86	26.00		78.00					.13	4.00		12.00												0.86	26.00		78.00				.13	4.00		10.00				26.00				0.83	26.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_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							275.00				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	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							125.00				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	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					653.00	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	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							275.00				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	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					656.00	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	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							125.00				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	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1291	001	0	1	09	04	H1291_001_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1291	001	0	1	09	04	H1291_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		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												
H1291	001	0	1	09	04	H1291_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		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												
H1291	001	0	1	09	04	H1291_001_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		54.00				0.60	18.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1291	001	0	1	09	04	H1291_001_0	3	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		27.00				0.30	9.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1291	001	0	1	09	04	H1291_001_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		54.00				0.60	18.00		0.00				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	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		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										2	3	
H1291	001	0	1	09	04	H1291_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		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										2	3	
H1291	001	0	1	09	04	H1291_001_0	3	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		27.00				0.30	9.00		0.00				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	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																								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	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																								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	6	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	6	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	6	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	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																								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	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																								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	6	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	6	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	6	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												
H1303	001	0	1	04	01	H1303_001_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	001	0	1	04	01	H1303_001_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	001	0	1	04	01	H1303_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																															285.00							275.00				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	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							125.00				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	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												
H1303	007	0	1	04	01	H1303_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																															135.00							125.00				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	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							275.00				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	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					711.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	007	0	1	04	01	H1303_007_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	007	0	1	04	01	H1303_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	002	0	1	04	01	H1304_002_0	9	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.50	15.00		30.00																					0.50	15.00		30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	002	0	1	04	01	H1304_002_0	9	3	Preferred Brand	1	3	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												
H1304	002	0	1	04	01	H1304_002_0	9	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	002	0	1	04	01	H1304_002_0	9	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					1154.00	28																							28																			28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	002	0	1	04	01	H1304_002_0	9	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		20.00																					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	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	9	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												
H1304	004	0	1	04	01	H1304_004_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.40	12.00		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		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												
H1304	004	0	1	04	01	H1304_004_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	009	0	1	04	01	H1304_009_0	9	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		20.00																					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	9	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.50	15.00		30.00																					0.50	15.00		30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	009	0	1	04	01	H1304_009_0	9	3	Preferred Brand	1	3	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												
H1304	009	0	1	04	01	H1304_009_0	9	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	009	0	1	04	01	H1304_009_0	9	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					1113.00	27																							27																			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	010	0	1	04	01	H1304_010_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		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												
H1304	010	0	1	04	01	H1304_010_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.40	12.00		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	010	0	1	04	01	H1304_010_0	9	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												
H1304	010	0	1	04	01	H1304_010_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	010	0	1	04	01	H1304_010_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	001	0	1	02	01	H1350_001_0	5	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	02	01	H1350_001_0	5	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	001	0	1	02	01	H1350_001_0	5	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	02	01	H1350_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												
H1350	001	0	1	02	01	H1350_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												
H1350	001	0	1	02	01	H1350_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																								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	02	01	H1350_001_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																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	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	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	012	0	1	01	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	01	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												
H1350	012	0	1	01	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	01	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	01	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												
H1365	001	0	1	04	01	H1365_001_0	7	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.20	6.00	12.00	18.00					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	7	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					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	7	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					1.33	40.00	80.00	120.00					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	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												
H1365	001	0	1	04	01	H1365_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	270.00					3.17	95.00	190.00	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	7	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					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	7	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.20	6.00	12.00	18.00					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	7	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					1.33	40.00	80.00	120.00					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	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	270.00					3.17	95.00	190.00	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_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												
H1365	003	0	1	04	01	H1365_003_0	7	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					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	7	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.20	6.00	12.00	18.00					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	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	270.00					3.17	95.00	190.00	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	003	0	1	04	01	H1365_003_0	7	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					1.33	40.00	80.00	120.00					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	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												
H1406	013	0	1	01	01	H1406_013_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1406	013	0	1	01	01	H1406_013_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H1406	013	0	1	01	01	H1406_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		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										2	3	
H1406	013	0	1	01	01	H1406_013_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	013	0	1	01	01	H1406_013_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_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		45.00				0.50	15.00		0.00				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	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		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												
H1406	022	0	1	01	01	H1406_022_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		18.00				0.20	6.00		0.00				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	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		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										2	3	
H1406	022	0	1	01	01	H1406_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		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										2	3	
H1406	022	0	1	01	01	H1406_022_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		45.00				0.50	15.00		0.00				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	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1406	022	0	1	01	01	H1406_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		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												
H1406	022	0	1	01	01	H1406_022_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	026	0	1	01	01	H1406_026_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1406	026	0	1	01	01	H1406_026_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		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												
H1406	026	0	1	01	01	H1406_026_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	026	0	1	01	01	H1406_026_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H1406	026	0	1	01	01	H1406_026_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		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										2	3	
H1406	026	0	1	01	01	H1406_026_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		45.00				0.50	15.00		0.00				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	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H1406	028	0	1	01	01	H1406_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		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										2	3	
H1406	028	0	1	01	01	H1406_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				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	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	028	0	1	01	01	H1406_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		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												
H1406	028	0	1	01	01	H1406_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		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												
H1406	028	0	1	01	01	H1406_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	029	0	1	01	01	H1406_029_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1406	029	0	1	01	01	H1406_029_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1406	029	0	1	01	01	H1406_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		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 Care Drugs										2	3	
H1406	029	0	1	01	01	H1406_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		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, Select Care Drugs										2	3	
H1406	029	0	1	01	01	H1406_029_0	4	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1406	029	0	1	01	01	H1406_029_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1406	029	0	1	01	01	H1406_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		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, Select Care Drugs												
H1406	029	0	1	01	01	H1406_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		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 Care Drugs												
H1406	029	0	1	01	01	H1406_029_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1406	029	0	1	01	01	H1406_029_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1406	029	0	1	01	01	H1406_029_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1406	030	0	1	01	01	H1406_030_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		45.00				0.50	15.00		0.00				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	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		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										2	3	
H1406	030	0	1	01	01	H1406_030_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		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										2	3	
H1406	030	0	1	01	01	H1406_030_0	5	5	Specialty Tier	3	4	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										2	3	
H1406	030	0	1	01	01	H1406_030_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		18.00				0.20	6.00		0.00				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	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		45.00				0.50	15.00		0.00				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	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		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												
H1406	030	0	1	01	01	H1406_030_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		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												
H1406	030	0	1	01	01	H1406_030_0	5	5	Specialty Tier	1	4	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												
H1406	030	0	1	01	01	H1406_030_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	031	0	1	01	01	H1406_031_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												
H1406	031	0	1	01	01	H1406_031_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.46	14.00		42.00																												0.46	14.00		42.00				0.46	14.00		0.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	031	0	1	01	01	H1406_031_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	031	0	1	01	01	H1406_031_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		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												
H1406	031	0	1	01	01	H1406_031_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		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												
H1415	021	0	1	02	01	H1415_021_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		15.00																		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	5	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		45.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00		270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					647.93	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				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	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.80	24.00		72.00					0.06	2.00		6.00												0.80	24.00		72.00				0.06	2.00		5.00				24.00				0.77	24.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.66	20.00		60.00					.43	13.00		39.00												.66	20.00		60.00				.43	13.00		32.50				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	7	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.20	6.00		18.00					.10	3.00		9.00												.20	6.00		18.00				.10	3.00		0.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_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					1.23	37.00		111.00												1.50	45.00		135.00				1.23	37.00		92.50				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	7	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									2.90	87.00		261.00					2.30	69.00		207.00												2.90	87.00		261.00				2.30	69.00		172.50				87.00				2.80	87.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	7	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	7	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.10	3.00		9.00												.96	29.00		87.00				.10	3.00		7.50				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	7	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.20	36.00		108.00												1.50	45.00		135.00				1.20	36.00		90.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	7	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.90	87.00		261.00												3.16	95.00		285.00				2.90	87.00		217.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	7	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	002	0	1	04	01	H1417_002_0	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		30.00					0.00	0.00		0.00					.33	10.00		30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	002	0	1	04	01	H1417_002_0	3	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					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	3	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												
H1417	002	0	1	04	01	H1417_002_0	3	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												
H1417	002	0	1	04	01	H1417_002_0	3	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	28		28					1.00	28		28					28		28																	28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	004	0	1	04	01	H1417_004_0	3	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					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	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		30.00					0.00	0.00		0.00					.33	10.00		30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	004	0	1	04	01	H1417_004_0	3	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												
H1417	004	0	1	04	01	H1417_004_0	3	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	26		26					1.00	26		26					26		26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	004	0	1	04	01	H1417_004_0	3	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												
H1417	010	0	1	04	01	H1417_010_0	3	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					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	010	0	1	04	01	H1417_010_0	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		30.00					0.00	0.00		0.00					.33	10.00		30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	010	0	1	04	01	H1417_010_0	3	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												
H1417	010	0	1	04	01	H1417_010_0	3	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												
H1417	010	0	1	04	01	H1417_010_0	3	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												
H1418	002	0	1	04	01	H1418_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	002	0	1	04	01	H1418_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		45.00				0.50	15.00		0.00				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	4	5	Specialty Tier	1	4	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												
H1418	002	0	1	04	01	H1418_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		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												
H1418	002	0	1	04	01	H1418_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		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												
H1418	002	0	1	04	01	H1418_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	002	0	1	04	01	H1418_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		18.00				0.20	6.00		0.00				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	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		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										2	3	
H1418	002	0	1	04	01	H1418_002_0	4	5	Specialty Tier	3	4	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										2	3	
H1418	002	0	1	04	01	H1418_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		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										2	3	
H1418	007	0	1	04	01	H1418_007_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		18.00				0.20	6.00		0.00				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	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		45.00				0.50	15.00		0.00				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	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		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												
H1418	007	0	1	04	01	H1418_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		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												
H1418	007	0	1	04	01	H1418_007_0	4	5	Specialty Tier	3	4	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										2	3	
H1418	007	0	1	04	01	H1418_007_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	007	0	1	04	01	H1418_007_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		45.00				0.50	15.00		0.00				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	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		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										2	3	
H1418	007	0	1	04	01	H1418_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		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										2	3	
H1418	007	0	1	04	01	H1418_007_0	4	5	Specialty Tier	1	4	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												
H1418	008	0	1	04	01	H1418_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		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												
H1418	008	0	1	04	01	H1418_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		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												
H1418	008	0	1	04	01	H1418_008_0	3	5	Specialty Tier	1	4	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												
H1418	008	0	1	04	01	H1418_008_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	008	0	1	04	01	H1418_008_0	3	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		24.00				0.26	8.00		0.00				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	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		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										2	3	
H1418	008	0	1	04	01	H1418_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		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										2	3	
H1418	008	0	1	04	01	H1418_008_0	3	5	Specialty Tier	3	4	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										2	3	
H1418	008	0	1	04	01	H1418_008_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		12.00				0.13	4.00		0.00				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	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1419	001	0	1	01	01	H1419_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1419	001	0	1	01	01	H1419_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.36	11.00	22.00	33.00					.23	7.00	14.00	21.00												.36	11.00	22.00	33.00				.23	7.00	14.00	21.00					11.00			.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1419	001	0	1	01	01	H1419_001_0	5	3	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	135.00												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												
H1419	001	0	1	01	01	H1419_001_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													48.45	50	50	50					46.32	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1419	001	0	1	01	01	H1419_001_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1419	001	0	1	01	01	H1419_001_0	5	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1444	001	0	1	01	01	H1444_001_0	8	1	Preferred Generic	1	2	001000	1	2	010		01			1	30													30		31	.13	4.00																																												4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1444	001	0	1	01	01	H1444_001_0	8	2	Non-Preferred Generic	1	2	000100	1	2	010		01			1	30													30		31	.40	12.00																																												12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1444	001	0	1	01	01	H1444_001_0	8	5	Specialty Tier	1	2	010010	1	1	010		01			1	30													30		31					496.62	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1444	001	0	1	01	01	H1444_001_0	8	4	Non-Preferred Brand	1	2	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												
H1444	001	0	1	01	01	H1444_001_0	8	3	Preferred Brand	1	2	000001	1	2	010		01			1	30													30		31	1.50	45.00																																												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	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		30.00					0.00	0.00		0.00					.33	10.00		30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	3	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												
H1463	003	0	1	01	01	H1463_003_0	3	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												
H1463	003	0	1	01	01	H1463_003_0	3	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					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	3	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												
H1463	009	0	1	01	01	H1463_009_0	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		30.00					0.00	0.00		0.00					.33	10.00		30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	3	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					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	3	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	26		26					1.00	26		26					26		26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	3	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												
H1463	009	0	1	01	01	H1463_009_0	3	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												
H1463	010	0	1	01	01	H1463_010_0	3	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												
H1463	010	0	1	01	01	H1463_010_0	3	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												
H1463	010	0	1	01	01	H1463_010_0	3	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					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	010	0	1	01	01	H1463_010_0	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		30.00					0.00	0.00		0.00					.33	10.00		30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	3	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	26		26					1.00	26		26					26		26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1468	007	0	1	01	01	H1468_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		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										2	3	
H1468	007	0	1	01	01	H1468_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		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										2	3	
H1468	007	0	1	01	01	H1468_007_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		45.00				0.50	15.00		0.00				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	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1468	007	0	1	01	01	H1468_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		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												
H1468	007	0	1	01	01	H1468_007_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				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	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		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												
H1509	001	0	1	04	01	H1509_001_0	2	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																															24.00							16.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	001	0	1	04	01	H1509_001_0	2	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							125.00				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	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	001	0	1	04	01	H1509_001_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					635.00	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	2	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																															24.00							16.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	009	0	1	04	01	H1509_009_0	2	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							125.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					518.00	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	2	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							275.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	010	0	1	04	01	H1509_010_0	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	010	0	1	04	01	H1509_010_0	2	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							275.00				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	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	010	0	1	04	01	H1509_010_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					656.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	011	0	1	04	01	H1509_011_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	011	0	1	04	01	H1509_011_0	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	011	0	1	04	01	H1509_011_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	011	0	1	04	01	H1509_011_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	011	0	1	04	01	H1509_011_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					635.00	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	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		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										2	3	
H1510	001	0	1	04	01	H1510_001_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1510	001	0	1	04	01	H1510_001_0	3	5	Specialty Tier	3	4	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										2	3	
H1510	001	0	1	04	01	H1510_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		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										2	3	
H1510	001	0	1	04	01	H1510_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		18.00				0.20	6.00		0.00				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	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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	001	0	1	04	01	H1510_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		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												
H1510	001	0	1	04	01	H1510_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		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												
H1510	001	0	1	04	01	H1510_001_0	3	5	Specialty Tier	1	4	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												
H1510	001	0	1	04	01	H1510_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	004	0	1	04	01	H1510_004_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	004	0	1	04	01	H1510_004_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		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										2	3	
H1510	004	0	1	04	01	H1510_004_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		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										2	3	
H1510	004	0	1	04	01	H1510_004_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1510	004	0	1	04	01	H1510_004_0	3	5	Specialty Tier	3	4	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										2	3	
H1510	004	0	1	04	01	H1510_004_0	3	5	Specialty Tier	1	4	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												
H1510	004	0	1	04	01	H1510_004_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		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												
H1510	004	0	1	04	01	H1510_004_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		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												
H1510	004	0	1	04	01	H1510_004_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	004	0	1	04	01	H1510_004_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	005	0	1	04	01	H1510_005_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		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										2	3	
H1510	005	0	1	04	01	H1510_005_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	005	0	1	04	01	H1510_005_0	3	5	Specialty Tier	1	4	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												
H1510	005	0	1	04	01	H1510_005_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		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												
H1510	005	0	1	04	01	H1510_005_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		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												
H1510	005	0	1	04	01	H1510_005_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	005	0	1	04	01	H1510_005_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		18.00				0.20	6.00		0.00				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	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		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										2	3	
H1510	005	0	1	04	01	H1510_005_0	3	5	Specialty Tier	3	4	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										2	3	
H1510	008	0	1	04	01	H1510_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		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												
H1510	008	0	1	04	01	H1510_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	008	0	1	04	01	H1510_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	008	0	1	04	01	H1510_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		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												
H1510	008	0	1	04	01	H1510_008_0	3	5	Specialty Tier	3	4	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										2	3	
H1510	008	0	1	04	01	H1510_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	008	0	1	04	01	H1510_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1510	008	0	1	04	01	H1510_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		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										2	3	
H1510	008	0	1	04	01	H1510_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		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										2	3	
H1510	008	0	1	04	01	H1510_008_0	3	5	Specialty Tier	1	4	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												
H1517	006	1	1	04	01	H1517_006_1	15	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	006	1	1	04	01	H1517_006_1	15	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.56	17.00	34.00	51.00					.40	12.00	24.00	36.00					.40	12.00	24.00	24.00																		17.00				.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	006	1	1	04	01	H1517_006_1	15	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.30	9.00	18.00	27.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	006	1	1	04	01	H1517_006_1	15	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	006	1	1	04	01	H1517_006_1	15	6	Select Care Drugs	1	3	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												
H1517	006	1	1	04	01	H1517_006_1	15	5	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, Specialty Tier, Select Care Drugs												
H1517	006	2	1	04	01	H1517_006_2	15	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.30	9.00	18.00	27.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	006	2	1	04	01	H1517_006_2	15	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.56	17.00	34.00	51.00					.40	12.00	24.00	36.00					.40	12.00	24.00	24.00																		17.00				.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	006	2	1	04	01	H1517_006_2	15	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	006	2	1	04	01	H1517_006_2	15	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	006	2	1	04	01	H1517_006_2	15	5	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, Specialty Tier, Select Care Drugs												
H1517	006	2	1	04	01	H1517_006_2	15	6	Select Care Drugs	1	3	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												
H1517	006	4	1	04	01	H1517_006_4	15	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.30	9.00	18.00	27.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	006	4	1	04	01	H1517_006_4	15	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.56	17.00	34.00	51.00					.40	12.00	24.00	36.00					.40	12.00	24.00	24.00																		17.00				.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	006	4	1	04	01	H1517_006_4	15	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	006	4	1	04	01	H1517_006_4	15	5	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, Specialty Tier, Select Care Drugs												
H1517	006	4	1	04	01	H1517_006_4	15	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	006	4	1	04	01	H1517_006_4	15	6	Select Care Drugs	1	3	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												
H1537	001	0	1	04	01	H1537_001_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					711.00	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	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1595	003	0	1	04	01	H1595_003_0	6	1	Generic	1	4	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	6	2	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	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	6	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												
H1595	003	0	1	04	01	H1595_003_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	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1595	004	0	1	04	01	H1595_004_0	6	1	Generic	1	2	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.33	10.00	20.00	25.00																					.33	10.00	20.00	25.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1595	004	0	1	04	01	H1595_004_0	6	2	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	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	004	0	1	04	01	H1595_004_0	6	3	Non-Preferred Brand	1	2	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	004	0	1	04	01	H1595_004_0	6	4	Specialty Tier	1	2	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	012	0	1	04	01	H1607_012_0	15	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.83	25.00	50.00	75.00					.66	20.00	40.00	60.00					.66	20.00	40.00	40.00																		25.00				.73	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	15	6	Select Care Drugs	1	3	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												
H1607	012	0	1	04	01	H1607_012_0	15	5	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, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	15	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	15	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	15	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1608	001	0	1	04	01	H1608_001_0	10	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.23	7.00	14.00	21.00					.10	3.00	6.00	9.00					.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	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							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	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	30.00					.23	7.00	14.00	21.00					.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	001	0	1	04	01	H1608_001_0	10	3	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	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												
H1608	001	0	1	04	01	H1608_001_0	10	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													53.75	50	50	50					50.40	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													43.01	50	50	50					38.18	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	7	3	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	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												
H1608	004	0	1	04	01	H1608_004_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					.06	2.00	4.00	6.00					.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	004	0	1	04	01	H1608_004_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.23	7.00	14.00	21.00					.13	4.00	8.00	12.00					.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	7	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					.06	2.00	4.00	6.00					.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	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.23	7.00	14.00	21.00					.13	4.00	8.00	12.00					.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	3	3	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	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												
H1608	007	0	1	04	01	H1608_007_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													49.95	50	50	50					47.97	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					.06	2.00	4.00	6.00					.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	008	0	1	04	01	H1608_008_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.23	7.00	14.00	21.00					.13	4.00	8.00	12.00					.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	3	3	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	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												
H1608	008	0	1	04	01	H1608_008_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													49.77	50	50	50					47.76	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	30.00					.23	7.00	14.00	21.00					.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	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.23	7.00	14.00	21.00					.10	3.00	6.00	9.00					.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	7	3	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	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												
H1609	001	0	1	01	01	H1609_001_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													47.03	50	50	50					45.09	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.23	7.00	14.00	21.00					.13	4.00	8.00	12.00					.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	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					.06	2.00	4.00	6.00					.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	5	3	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	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												
H1609	009	0	1	01	01	H1609_009_0	5	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													35.23	50	50	50					33.13	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	010	0	1	01	01	H1609_010_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					.06	2.00	4.00	6.00					.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	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.23	7.00	14.00	21.00					.13	4.00	8.00	12.00					.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	010	0	1	01	01	H1609_010_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													51.07	50	50	50					47.79	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	010	0	1	01	01	H1609_010_0	5	3	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	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												
H1609	010	0	1	01	01	H1609_010_0	5	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.60	18.00		54.00																					.60	18.00		36.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	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												
H1659	001	0	1	04	01	H1659_001_0	8	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												
H1659	001	0	1	04	01	H1659_001_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		160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	8	5	Specialty Tier	1	4	110001	1	1	110		01	110		1	30		90				1	30		90				30		31					275.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.60	18.00		54.00																					.60	18.00		36.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	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												
H1659	002	0	1	04	01	H1659_002_0	8	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												
H1659	002	0	1	04	01	H1659_002_0	8	5	Specialty Tier	1	4	110001	1	1	110		01	110		1	30		90				1	30		90				30		31					275.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_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		160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	8	1	Preferred Generic	1	4	001000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.83	25.00		75.00																					.83	25.00		50.00																		25.00				.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	8	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																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_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		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	8	5	Specialty Tier	1	4	110001	1	1	110		01	110		1	30		90				1	30		90				30		31					275.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31						33		33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	9	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		90				1	30	60	90				30		31	0.13	4.00		12.00																					.08	2.66	5.33	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	9	2	Non-Preferred Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	0.33	10.00		30.00																					.22	6.66	13.33	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	9	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	1.50	45.00		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												
H1660	001	0	1	01	01	H1660_001_0	9	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	3.16	95.00		285.00																					2.11	63.33	126.66	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	9	1	Preferred Generic	3	4	001000	3	2	110		01	111		1	30		90				1	30	60	90				30		31	.13	4.00		12.00																					.08	2.66	5.33	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	001	0	1	01	01	H1660_001_0	9	2	Non-Preferred Generic	3	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	.33	10.00		30.00																					.22	6.66	13.33	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	004	0	1	01	01	H1660_004_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31						33		33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	004	0	1	01	01	H1660_004_0	9	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	3.16	95.00		285.00																					2.11	63.30	126.60	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	004	0	1	01	01	H1660_004_0	9	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	1.50	45.00		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												
H1660	004	0	1	01	01	H1660_004_0	9	2	Non-Preferred Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	0.33	10.00		30.00																					.22	6.66	13.32	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	004	0	1	01	01	H1660_004_0	9	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		90				1	30	60	90				30		31	0.13	4.00		12.00																					.09	2.66	5.32	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	004	0	1	01	01	H1660_004_0	9	1	Preferred Generic	3	4	001000	3	2	110		01	111		1	30		90				1	30	60	90				30		31	.13	4.00		12.00																					.08	2.66	5.33	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	004	0	1	01	01	H1660_004_0	9	2	Non-Preferred Generic	3	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	.33	10.00		30.00																					0.22	6.66	13.33	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	005	0	1	01	01	H1660_005_0	9	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		90				1	30	60	90				30		31	0.13	4.00		12.00																					.08	2.66	5.33	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	005	0	1	01	01	H1660_005_0	9	2	Non-Preferred Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	0.33	10.00		30.00																					.22	6.66	13.33	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	005	0	1	01	01	H1660_005_0	9	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	1.50	45.00		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												
H1660	005	0	1	01	01	H1660_005_0	9	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	3.16	95.00		285.00																					2.11	63.33	126.66	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	005	0	1	01	01	H1660_005_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31						33		33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	005	0	1	01	01	H1660_005_0	9	1	Preferred Generic	3	4	001000	3	2	110		01	111		1	30		90				1	30	60	90				30		31	.13	4.00		12.00																					.08	2.66	5.33	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	005	0	1	01	01	H1660_005_0	9	2	Non-Preferred Generic	3	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	.33	10.00		30.00																					0.22	6.66	13.33	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	009	0	1	01	01	H1660_009_0	9	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		90				1	30	60	90				30		31	.13	4.00		12.00																					.08	2.66	4.00	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	9	2	Non-Preferred Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	.33	10.00		30.00																					.22	6.66	10.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	9	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	1.50	45.00		135.00																					1.00	30.00	45.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	9	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	3.16	95.00		285.00																					2.11	65.00	95.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31						25		25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	9	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	3.16	95.00		285.00																					2.11	63.33	126.66	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	9	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	1.50	45.00		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												
H1660	012	0	1	01	01	H1660_012_0	9	2	Non-Preferred Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	.33	10.00		30.00																					.22	6.66	10.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	9	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		90				1	30	60	90				30		31	.13	4.00		12.00																					.08	2.66	4.00	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31					1000.00	25		25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	9	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	3.16	95.00		285.00																					2.11	63.33	126.66	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	9	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	1.50	45.00		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												
H1660	013	0	1	01	01	H1660_013_0	9	2	Non-Preferred Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	0.33	10.00		30.00																					.22	6.66	13.33	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	9	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		90				1	30	60	90				30		31	0.13	4.00		12.00																					.08	2.66	5.33	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31						33		33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	12	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	12	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	12	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	12	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	13	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	13	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	13	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	13	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	13	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	12	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	12	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	12	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	12	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	10	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	10	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	10	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	10	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	10	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	10	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	001	0	1	01	01	H1692_001_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.23	7.00	14.00	21.00					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												
H1692	001	0	1	01	01	H1692_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.70	21.00	42.00	63.00					0.36	11.00	22.00	33.00					0.36	11.00	22.00	33.00																			21.00			0.67	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	001	0	1	01	01	H1692_001_0	4	3	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	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												
H1692	001	0	1	01	01	H1692_001_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													57.46	50	50	50					56.35	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	001	0	1	01	01	H1692_001_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.20	6.00	12.00	18.00					0.20	6.00	12.00	18.00																			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	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.63	19.00	38.00	57.00					0.30	9.00	18.00	27.00					0.30	9.00	18.00	27.00																			19.00			0.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	3	3	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	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												
H1692	002	0	1	01	01	H1692_002_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													56.41	50	50	50					55.37	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		36.00				0.40	12.00		0.00				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	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		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												
H1716	001	0	1	04	01	H1716_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		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												
H1716	001	0	1	04	01	H1716_001_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1716	001	0	1	04	01	H1716_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		36.00				0.40	12.00		0.00				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	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		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										2	3	
H1716	001	0	1	04	01	H1716_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		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										2	3	
H1716	001	0	1	04	01	H1716_001_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	020	0	1	04	01	H1716_020_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					0.03	1.00		3.00												0.20	6.00		18.00				0.03	1.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	020	0	1	04	01	H1716_020_0	3	5	Specialty Tier	3	4	010010	1	1		010	01		010	1				30							30			30		31														27								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	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					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		260.00				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	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		110.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1716	020	0	1	04	01	H1716_020_0	3	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					0.10	3.00		9.00												0.30	9.00		27.00				0.10	3.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	020	0	1	04	01	H1716_020_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								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	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					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		260.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	020	0	1	04	01	H1716_020_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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		110.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	020	0	1	04	01	H1716_020_0	3	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					0.10	3.00		9.00												0.30	9.00		27.00				0.10	3.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1723	001	0	1	48	05	H1723_001_0	10	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			
H1723	001	0	1	48	05	H1723_001_0	10	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			
H1723	001	0	1	48	05	H1723_001_0	10	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			
H1737	001	0	1	01	01	H1737_001_0	3	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												
H1737	001	0	1	01	01	H1737_001_0	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.26	8.00		24.00					0.00	0.00		0.00					.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	3	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					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	3	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												
H1737	001	0	1	01	01	H1737_001_0	3	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												
H1737	003	0	1	01	01	H1737_003_0	3	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	32		32					1.00	32		32					32		32																	32				32	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	003	0	1	01	01	H1737_003_0	3	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												
H1737	003	0	1	01	01	H1737_003_0	3	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												
H1737	003	0	1	01	01	H1737_003_0	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.26	8.00		24.00					0.00	0.00		0.00					.26	8.00		24.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	003	0	1	01	01	H1737_003_0	3	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					1.10	33.00		99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	001	0	1	04	01	H1846_001_0	8	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	8	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	8	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	8	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	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																					0.00	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	8	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	001	0	1	04	01	H1846_001_0	8	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	003	0	1	04	01	H1846_003_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																					0.00	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	9	2	Non-Preferred Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.50	15.00	30.00	45.00																					0.50	15.00	30.00	30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	003	0	1	04	01	H1846_003_0	9	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	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	180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	003	0	1	04	01	H1846_003_0	9	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	017	0	1	01	01	H1849_017_0	12	5	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, Specialty Tier, Select Care Drugs												
H1849	017	0	1	01	01	H1849_017_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	017	0	1	01	01	H1849_017_0	12	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					1.03	31.00	62.00	93.00					1.03	31.00	93.00	93.00																		31.00				.91	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	017	0	1	01	01	H1849_017_0	12	2	Non-Preferred Generic	1	3	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	30.00					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	017	0	1	01	01	H1849_017_0	12	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.16	5.00	10.00	15.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	017	0	1	01	01	H1849_017_0	12	6	Select Care Drugs	1	3	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												
H1849	018	0	1	01	01	H1849_018_0	14	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.63	19.00	38.00	57.00					.46	14.00	28.00	42.00					.46	14.00	28.00	28.00																		19.00				.55	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_0	14	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.30	9.00	18.00	27.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_0	14	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_0	14	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_0	14	5	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, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_0	14	6	Select Care Drugs	1	3	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												
H1894	001	0	1	01	01	H1894_001_0	9	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					.50	15.00	30.00	45.00					.50	15.00	30.00	30.00																		20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	9	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	9	6	Select Care Drugs	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												
H1894	001	0	1	01	01	H1894_001_0	9	5	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, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	9	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	8	1	Preferred Generic	1	3	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	15.00					0.16	5.00	10.00	10.00																		5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	8	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					0.20	6.00	12.00	18.00					0.20	6.00	12.00	12.00																		6.00				0.17	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	8	5	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, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	8	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					1.20	36.00	72.00	108.00					1.20	36.00	108.00	108.00																		36.00				1.05	36.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	8	6	Select Care Drugs	1	3	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												
H1903	011	0	1	01	01	H1903_011_0	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	011	0	1	01	01	H1903_011_0	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.83	25.00		75.00					.06	2.00		6.00												.83	25.00		75.00				.06	2.00		5.00				25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	011	0	1	01	01	H1903_011_0	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				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	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.80	84.00		252.00												3.16	95.00		285.00				2.80	84.00		210.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									1.00	30.00		90.00					.50	15.00		45.00												1.00	30.00		90.00				.50	15.00		37.50				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_0	7	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					.10	3.00		9.00												.33	10.00		30.00				.10	3.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_0	7	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	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		18.00				0.20	6.00		0.00				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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		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		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												
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		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												
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						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		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		36.00				0.40	12.00		0.00				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	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		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										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		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										2	3	
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						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1916	001	0	1	48	05	H1916_001_0	9	2	Brand Drugs	1	4	000010			110		01	010		1	30		90				1	30						30		34																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1916	001	0	1	48	05	H1916_001_0	9	1	Generic Drugs	1	4	010000			110		01	010		1	30		90				1	30						30		34																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1944	001	0	1	01	01	H1944_001_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															9.00							6.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	2	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																															33.00							22.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	2	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							125.00				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	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					514.00	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															9.00							6.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	2	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																															33.00							22.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	2	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							125.00				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	2	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							275.00				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	2	5	Specialty Tier	1	3	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												
H1951	001	0	1	01	01	H1951_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		15.00				0.16	5.00		0.00				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	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		30.00				0.33	10.00		0.00				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	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H1951	001	0	1	01	01	H1951_001_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		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										2	3	
H1951	001	0	1	01	01	H1951_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		30.00				0.33	10.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	001	0	1	01	01	H1951_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1951	001	0	1	01	01	H1951_001_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		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												
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		15.00				0.16	5.00		0.00				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	2.83	85.00		255.00																												2.83	85.00		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										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	1.50	45.00		135.00																												1.50	45.00		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										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		30.00				0.33	10.00		0.00				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						28																														28							28					28				28	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						28																														28							28					28				28	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	2.83	85.00		255.00																												2.83	85.00		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												
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	1.50	45.00		135.00																												1.50	45.00		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												
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		30.00				0.33	10.00		0.00				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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	013	0	1	01	01	H1951_013_0	3	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		18.00				0.20	6.00		0.00				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		30.00				0.33	10.00		0.00				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		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												
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		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												
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						28																														28							28					28				28	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	013	0	1	01	01	H1951_013_0	3	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		30.00				0.33	10.00		0.00				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		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										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		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										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						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	024	0	1	01	01	H1951_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		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												
H1951	024	0	1	01	01	H1951_024_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	024	0	1	01	01	H1951_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		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										2	3	
H1951	024	0	1	01	01	H1951_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		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										2	3	
H1951	024	0	1	01	01	H1951_024_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		36.00				0.40	12.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	024	0	1	01	01	H1951_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_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		36.00				0.40	12.00		0.00				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	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		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												
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		36.00				0.40	12.00		0.00				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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		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	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		36.00				0.40	12.00		0.00				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	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		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										2	3	
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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	025	0	1	01	01	H1951_025_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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						28																														28							28					28				28	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		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												
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		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												
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		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										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	3.16	95.00		285.00																												3.16	95.00		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										2	3	
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		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										2	3	
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		36.00				0.40	12.00		0.00				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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	028	0	1	01	01	H1951_028_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	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	3.16	95.00		285.00																												3.16	95.00		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												
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		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												
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						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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		15.00				0.16	5.00		0.00				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	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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		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		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												
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	1.50	45.00		135.00																												1.50	45.00		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												
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	0.13	4.00		12.00																												0.13	4.00		12.00				0.13	4.00		0.00				4.00				0.12	4.00		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						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	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		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												
H1951	033	0	1	01	01	H1951_033_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		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												
H1951	033	0	1	01	01	H1951_033_0	5	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_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	033	0	1	01	01	H1951_033_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						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	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	034	0	1	01	01	H1951_034_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		15.00				0.16	5.00		0.00				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	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		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												
H1951	034	0	1	01	01	H1951_034_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		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												
H1951	034	0	1	01	01	H1951_034_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						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		15.00				0.16	5.00		0.00				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	1.50	45.00		135.00																												1.50	45.00		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												
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		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												
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						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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	1.50	45.00		135.00																												1.50	45.00		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 Care Drugs												
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	2.83	85.00		255.00																												2.83	85.00		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, Select Care Drugs												
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						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	036	0	1	01	01	H1951_036_0	3	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										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	1.50	45.00		135.00																												1.50	45.00		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 Care Drugs										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	2.83	85.00		255.00																												2.83	85.00		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, Select Care Drugs										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						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	036	0	1	01	01	H1951_036_0	3	6	Select Care Drugs	3	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1951	037	0	1	01	01	H1951_037_0	3	6	Select Care Drugs	3	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
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		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, Select Care Drugs										2	3	
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		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 Care Drugs										2	3	
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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	037	0	1	01	01	H1951_037_0	3	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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		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, Select Care Drugs												
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		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 Care Drugs												
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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	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		30.00				0.33	10.00		0.00				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	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		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												
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		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												
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						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	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		30.00				0.33	10.00		0.00				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		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										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		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										2	3	
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						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	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		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												
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		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												
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		30.00				0.33	10.00		0.00				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	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	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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		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										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		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										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		30.00				0.33	10.00		0.00				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						33																														33							33					33				33	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	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		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												
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		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												
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						28																														28							28					28				28	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	0.26	8.00		24.00																												0.26	8.00		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	042	0	1	01	01	H1951_042_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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H1951	042	0	1	01	01	H1951_042_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		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										2	3	
H1951	042	0	1	01	01	H1951_042_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H1951	042	0	1	01	01	H1951_042_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	042	0	1	01	01	H1951_042_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		30.00				0.33	10.00		0.00				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	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		18.00				0.20	6.00		0.00				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	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		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												
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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	1.50	45.00		135.00																												1.50	45.00		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 Care Drugs												
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	2.83	85.00		255.00																												2.83	85.00		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, Select Care Drugs												
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						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	043	0	1	01	01	H1951_043_0	3	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										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	1.50	45.00		135.00																												1.50	45.00		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 Care Drugs										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	2.83	85.00		255.00																												2.83	85.00		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, Select Care Drugs										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						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	043	0	1	01	01	H1951_043_0	3	6	Select Care Drugs	3	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1951	044	0	1	01	01	H1951_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, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_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		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 Care Drugs												
H1951	044	0	1	01	01	H1951_044_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		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, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	3	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1951	044	0	1	01	01	H1951_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, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1951	044	0	1	01	01	H1951_044_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		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 Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_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		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, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_0	3	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1961	002	0	1	01	01	H1961_002_0	6	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	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				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	002	0	1	01	01	H1961_002_0	6	3	Preferred Brand	1	4	010001	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	6	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				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	002	0	1	01	01	H1961_002_0	6	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	6	5	Specialty Tier	1	4	010010	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	6	4	Non-Preferred Brand	1	4	110000	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	007	0	1	01	01	H1961_007_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																								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	8	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	8	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				2			90				30		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												
H1961	007	0	1	01	01	H1961_007_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				2			90				30		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												
H1961	007	0	1	01	01	H1961_007_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					515.27	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_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																								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	8	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				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	009	0	1	01	01	H1961_009_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				3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	009	0	1	01	01	H1961_009_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				3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	009	0	1	01	01	H1961_009_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							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	009	0	1	01	01	H1961_009_0	7	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				2						90	30		31	1.29	40.00		120.00																															120.00							120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	009	0	1	01	01	H1961_009_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							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	009	0	1	01	01	H1961_009_0	7	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				2						90	30		31					498.94	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	009	0	1	01	01	H1961_009_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				2						90	30		31	2.58	80.00		240.00																															240.00							240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	012	0	1	01	01	H1961_012_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				2						90	30		31	2.67	80.00		240.00																															240.00							240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	012	0	1	01	01	H1961_012_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				2						90	30		31	1.29	40.00		120.00																															120.00							120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	012	0	1	01	01	H1961_012_0	6	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							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	012	0	1	01	01	H1961_012_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				2						90	30		31	.13	4.00		12.00																															12.00							4.00				4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	012	0	1	01	01	H1961_012_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				2						90	30		31					1204.94	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	012	0	1	01	01	H1961_012_0	6	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							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	012	0	1	01	01	H1961_012_0	6	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				2						90	30		31	.13	4.00		12.00																															12.00							4.00				4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	014	1	1	01	01	H1961_014_1	6	4	Non-Preferred Brand	1	4	110000	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	014	1	1	01	01	H1961_014_1	6	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				2			90				30		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												
H1961	014	1	1	01	01	H1961_014_1	6	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	014	1	1	01	01	H1961_014_1	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		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												
H1961	014	1	1	01	01	H1961_014_1	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					498.94	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		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		
H1961	014	1	1	01	01	H1961_014_1	6	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				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	014	2	1	01	01	H1961_014_2	6	4	Non-Preferred Brand	1	4	110000	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	014	2	1	01	01	H1961_014_2	6	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				2			90				30		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												
H1961	014	2	1	01	01	H1961_014_2	6	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	014	2	1	01	01	H1961_014_2	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		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												
H1961	014	2	1	01	01	H1961_014_2	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					498.94	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	6	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				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	014	2	1	01	01	H1961_014_2	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		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		
H1969	002	0	1	01	01	H1969_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		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												
H1969	002	0	1	01	01	H1969_002_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		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1969	002	0	1	01	01	H1969_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		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												
H1969	002	0	1	01	01	H1969_002_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1969	002	0	1	01	01	H1969_002_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1969	003	0	1	01	01	H1969_003_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.10	3.00		6.00																					0.10	3.00		6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1969	003	0	1	01	01	H1969_003_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		20.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1969	003	0	1	01	01	H1969_003_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		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												
H1969	003	0	1	01	01	H1969_003_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1969	003	0	1	01	01	H1969_003_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1977	001	0	1	48	05	H1977_001_0	3	2	Brand Drugs	1	4	000010			010		01			1	30													30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00			0.00	0.00			
H1977	001	0	1	48	05	H1977_001_0	3	1	Generic Drugs	1	4	010000			010		01			1	30													30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00			0.00	0.00			
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	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												
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	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1153.00	33																							33																			33				33	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	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	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												
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					933.00	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	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	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	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	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	02	01	H1994_003_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.17	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	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1448.00	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	10	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												
H1994	003	0	1	02	01	H1994_003_0	10	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	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	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	10	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												
H1994	004	0	1	02	01	H1994_004_0	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1020.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	02	01	H1994_004_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.17	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	10	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	005	0	1	02	01	H1994_005_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	005	0	1	02	01	H1994_005_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	005	0	1	02	01	H1994_005_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1194.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	005	0	1	02	01	H1994_005_0	8	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												
H1994	005	0	1	02	01	H1994_005_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	006	0	1	02	01	H1994_006_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1153.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	006	0	1	02	01	H1994_006_0	8	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												
H1994	006	0	1	02	01	H1994_006_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	006	0	1	02	01	H1994_006_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	006	0	1	02	01	H1994_006_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												
H1997	002	0	1	01	01	H1997_002_0	9	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												
H1997	002	0	1	01	01	H1997_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.40	12.00		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.13	4.00		8.00																					0.13	4.00		8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	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	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_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																															27.00							18.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	001	0	1	04	01	H2001_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																															135.00							125.00				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	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							275.00				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	4	5	Specialty Tier	1	3	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												
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	002	0	1	01	01	H2012_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	002	0	1	01	01	H2012_002_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	002	0	1	01	01	H2012_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		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												
H2012	002	0	1	01	01	H2012_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		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												
H2012	002	0	1	01	01	H2012_002_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	002	0	1	01	01	H2012_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	002	0	1	01	01	H2012_002_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	002	0	1	01	01	H2012_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		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										2	3	
H2012	002	0	1	01	01	H2012_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		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										2	3	
H2012	002	0	1	01	01	H2012_002_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_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		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												
H2012	003	0	1	01	01	H2012_003_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		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												
H2012	003	0	1	01	01	H2012_003_0	3	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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_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												
H2012	003	0	1	01	01	H2012_003_0	3	5	Specialty Tier	1	3	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												
H2012	006	0	1	01	01	H2012_006_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	006	0	1	01	01	H2012_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		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										2	3	
H2012	006	0	1	01	01	H2012_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		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										2	3	
H2012	006	0	1	01	01	H2012_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	006	0	1	01	01	H2012_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	006	0	1	01	01	H2012_006_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	01	01	H2012_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		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												
H2012	006	0	1	01	01	H2012_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	01	01	H2012_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	01	01	H2012_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		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												
H2012	008	0	1	01	01	H2012_008_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	008	0	1	01	01	H2012_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		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												
H2012	008	0	1	01	01	H2012_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		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												
H2012	008	0	1	01	01	H2012_008_0	5	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	008	0	1	01	01	H2012_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	008	0	1	01	01	H2012_008_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	008	0	1	01	01	H2012_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		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										2	3	
H2012	008	0	1	01	01	H2012_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		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										2	3	
H2012	008	0	1	01	01	H2012_008_0	5	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	008	0	1	01	01	H2012_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_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		15.00				0.16	5.00		0.00				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	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		45.00				0.50	15.00		0.00				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	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		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												
H2012	009	0	1	01	01	H2012_009_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		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												
H2012	009	0	1	01	01	H2012_009_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	009	0	1	01	01	H2012_009_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		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										2	3	
H2012	009	0	1	01	01	H2012_009_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	009	0	1	01	01	H2012_009_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		45.00				0.50	15.00		0.00				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	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		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										2	3	
H2012	011	0	1	01	01	H2012_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		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										2	3	
H2012	011	0	1	01	01	H2012_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		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										2	3	
H2012	011	0	1	01	01	H2012_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		45.00				0.50	15.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	011	0	1	01	01	H2012_011_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	011	0	1	01	01	H2012_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		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												
H2012	011	0	1	01	01	H2012_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		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												
H2012	011	0	1	01	01	H2012_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		45.00				0.50	15.00		0.00				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	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		15.00				0.16	5.00		0.00				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	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	012	0	1	01	01	H2012_012_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	012	0	1	01	01	H2012_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	012	0	1	01	01	H2012_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		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												
H2012	012	0	1	01	01	H2012_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		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												
H2012	012	0	1	01	01	H2012_012_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	012	0	1	01	01	H2012_012_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	012	0	1	01	01	H2012_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	012	0	1	01	01	H2012_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		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										2	3	
H2012	012	0	1	01	01	H2012_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		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										2	3	
H2012	012	0	1	01	01	H2012_012_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	013	0	1	01	01	H2012_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		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												
H2012	013	0	1	01	01	H2012_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		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												
H2012	013	0	1	01	01	H2012_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	013	0	1	01	01	H2012_013_0	3	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		48.00				0.53	16.00		0.00				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	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		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										2	3	
H2012	013	0	1	01	01	H2012_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		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										2	3	
H2012	013	0	1	01	01	H2012_013_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	013	0	1	01	01	H2012_013_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	013	0	1	01	01	H2012_013_0	3	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		48.00				0.53	16.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_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		270.00				3.00	90.00		260.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	015	0	1	01	01	H2012_015_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	015	0	1	01	01	H2012_015_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		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										2	3	
H2012	015	0	1	01	01	H2012_015_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		270.00				3.00	90.00		260.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	015	0	1	01	01	H2012_015_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_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		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												
H2012	016	0	1	01	01	H2012_016_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		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												
H2012	016	0	1	01	01	H2012_016_0	4	5	Specialty Tier	1	3	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												
H2012	016	0	1	01	01	H2012_016_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		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												
H2012	016	0	1	01	01	H2012_016_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		60.00				0.66	20.00		0.00				20.00				0.64	20.00		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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_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		15.00				0.16	5.00		0.00				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	4	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		42.00				0.46	14.00		0.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	021	0	1	01	01	H2012_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		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												
H2012	021	0	1	01	01	H2012_021_0	4	5	Specialty Tier	3	4	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										2	3	
H2012	021	0	1	01	01	H2012_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		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												
H2012	021	0	1	01	01	H2012_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		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										2	3	
H2012	021	0	1	01	01	H2012_021_0	4	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		42.00				0.46	14.00		0.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	021	0	1	01	01	H2012_021_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	021	0	1	01	01	H2012_021_0	4	5	Specialty Tier	1	4	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												
H2012	021	0	1	01	01	H2012_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		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										2	3	
H2012	022	0	1	01	01	H2012_022_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		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										2	3	
H2012	022	0	1	01	01	H2012_022_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	022	0	1	01	01	H2012_022_0	3	5	Specialty Tier	1	4	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												
H2012	022	0	1	01	01	H2012_022_0	3	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		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										2	3	
H2012	022	0	1	01	01	H2012_022_0	3	5	Specialty Tier	3	4	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										2	3	
H2012	022	0	1	01	01	H2012_022_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		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										2	3	
H2012	022	0	1	01	01	H2012_022_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		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												
H2012	022	0	1	01	01	H2012_022_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		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												
H2012	022	0	1	01	01	H2012_022_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	022	0	1	01	01	H2012_022_0	3	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		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												
H2012	027	0	1	01	01	H2012_027_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		15.00				0.16	5.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	027	0	1	01	01	H2012_027_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		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										2	3	
H2012	027	0	1	01	01	H2012_027_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		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										2	3	
H2012	027	0	1	01	01	H2012_027_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		45.00				0.50	15.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	027	0	1	01	01	H2012_027_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	027	0	1	01	01	H2012_027_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		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												
H2012	027	0	1	01	01	H2012_027_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		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												
H2012	027	0	1	01	01	H2012_027_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		45.00				0.50	15.00		0.00				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	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		15.00				0.16	5.00		0.00				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	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		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												
H2012	028	0	1	01	01	H2012_028_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		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												
H2012	028	0	1	01	01	H2012_028_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	028	0	1	01	01	H2012_028_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		45.00				0.50	15.00		0.00				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	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		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										2	3	
H2012	028	0	1	01	01	H2012_028_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		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										2	3	
H2012	028	0	1	01	01	H2012_028_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	028	0	1	01	01	H2012_028_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		45.00				0.50	15.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	029	0	1	01	01	H2012_029_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		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										2	3	
H2012	029	0	1	01	01	H2012_029_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		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										2	3	
H2012	029	0	1	01	01	H2012_029_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	029	0	1	01	01	H2012_029_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	029	0	1	01	01	H2012_029_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_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		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												
H2012	029	0	1	01	01	H2012_029_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	029	0	1	01	01	H2012_029_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		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												
H2012	029	0	1	01	01	H2012_029_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		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	3.16	95.00		285.00																												3.16	95.00		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												
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	1.50	45.00		135.00																												1.50	45.00		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												
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	0.23	7.00		21.00																												0.23	7.00		21.00				0.23	7.00		0.00				7.00				0.22	7.00		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		12.00				0.13	4.00		0.00				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	5	Specialty Tier	3	4	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										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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	030	0	1	02	01	H2012_030_0	5	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		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	1.50	45.00		135.00																												1.50	45.00		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										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	3.16	95.00		285.00																												3.16	95.00		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										2	3	
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						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	031	0	1	01	01	H2012_031_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		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												
H2012	031	0	1	01	01	H2012_031_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		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												
H2012	031	0	1	01	01	H2012_031_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	031	0	1	01	01	H2012_031_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		12.00				0.13	4.00		0.00				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	3	5	Specialty Tier	1	4	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												
H2012	031	0	1	01	01	H2012_031_0	3	5	Specialty Tier	3	4	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										2	3	
H2012	031	0	1	01	01	H2012_031_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		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										2	3	
H2012	031	0	1	01	01	H2012_031_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		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										2	3	
H2012	031	0	1	01	01	H2012_031_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	031	0	1	01	01	H2012_031_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	033	0	1	01	01	H2012_033_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		12.00				0.13	4.00		0.00				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	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	033	0	1	01	01	H2012_033_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		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												
H2012	033	0	1	01	01	H2012_033_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		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												
H2012	033	0	1	01	01	H2012_033_0	4	5	Specialty Tier	3	4	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										2	3	
H2012	033	0	1	01	01	H2012_033_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		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										2	3	
H2012	033	0	1	01	01	H2012_033_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	033	0	1	01	01	H2012_033_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	033	0	1	01	01	H2012_033_0	4	5	Specialty Tier	1	4	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												
H2012	033	0	1	01	01	H2012_033_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		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										2	3	
H2012	035	0	1	01	01	H2012_035_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		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												
H2012	035	0	1	01	01	H2012_035_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		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												
H2012	035	0	1	01	01	H2012_035_0	3	5	Specialty Tier	1	4	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												
H2012	035	0	1	01	01	H2012_035_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	035	0	1	01	01	H2012_035_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	035	0	1	01	01	H2012_035_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		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										2	3	
H2012	035	0	1	01	01	H2012_035_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		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										2	3	
H2012	035	0	1	01	01	H2012_035_0	3	5	Specialty Tier	3	4	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										2	3	
H2012	035	0	1	01	01	H2012_035_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		12.00				0.13	4.00		0.00				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	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	037	0	1	01	01	H2012_037_0	3	5	Specialty Tier	1	4	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												
H2012	037	0	1	01	01	H2012_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		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												
H2012	037	0	1	01	01	H2012_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		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												
H2012	037	0	1	01	01	H2012_037_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	037	0	1	01	01	H2012_037_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	037	0	1	01	01	H2012_037_0	3	5	Specialty Tier	3	4	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										2	3	
H2012	037	0	1	01	01	H2012_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		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										2	3	
H2012	037	0	1	01	01	H2012_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		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										2	3	
H2012	037	0	1	01	01	H2012_037_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		21.00				0.23	7.00		0.00				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	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		12.00				0.13	4.00		0.00				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	3	5	Specialty Tier	1	4	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												
H2012	039	0	1	01	01	H2012_039_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		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												
H2012	039	0	1	01	01	H2012_039_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		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												
H2012	039	0	1	01	01	H2012_039_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	039	0	1	01	01	H2012_039_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		12.00				0.13	4.00		0.00				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	3	5	Specialty Tier	3	4	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										2	3	
H2012	039	0	1	01	01	H2012_039_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		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										2	3	
H2012	039	0	1	01	01	H2012_039_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	039	0	1	01	01	H2012_039_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	039	0	1	01	01	H2012_039_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		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										2	3	
H2012	042	0	1	01	01	H2012_042_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	042	0	1	01	01	H2012_042_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	042	0	1	01	01	H2012_042_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	042	0	1	01	01	H2012_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		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												
H2012	042	0	1	01	01	H2012_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		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												
H2012	051	0	1	01	01	H2012_051_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		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												
H2012	051	0	1	01	01	H2012_051_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		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												
H2012	051	0	1	01	01	H2012_051_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	051	0	1	01	01	H2012_051_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		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										2	3	
H2012	051	0	1	01	01	H2012_051_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		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										2	3	
H2012	051	0	1	01	01	H2012_051_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	051	0	1	01	01	H2012_051_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	051	0	1	01	01	H2012_051_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	051	0	1	01	01	H2012_051_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	051	0	1	01	01	H2012_051_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	053	0	1	01	01	H2012_053_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		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												
H2012	053	0	1	01	01	H2012_053_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		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												
H2012	053	0	1	01	01	H2012_053_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		30.00				0.33	10.00		0.00				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	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	053	0	1	01	01	H2012_053_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_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		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												
H2012	054	0	1	01	01	H2012_054_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		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												
H2012	054	0	1	01	01	H2012_054_0	3	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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_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												
H2012	054	0	1	01	01	H2012_054_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_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		45.00				0.50	15.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	055	0	1	01	01	H2012_055_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		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										2	3	
H2012	055	0	1	01	01	H2012_055_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		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										2	3	
H2012	055	0	1	01	01	H2012_055_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	055	0	1	01	01	H2012_055_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_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		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												
H2012	055	0	1	01	01	H2012_055_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		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												
H2012	056	0	1	01	01	H2012_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		15.00				0.16	5.00		0.00				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	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		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										2	3	
H2012	056	0	1	01	01	H2012_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		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										2	3	
H2012	056	0	1	01	01	H2012_056_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		45.00				0.50	15.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	056	0	1	01	01	H2012_056_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	056	0	1	01	01	H2012_056_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		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												
H2012	056	0	1	01	01	H2012_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		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												
H2012	056	0	1	01	01	H2012_056_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		45.00				0.50	15.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	060	0	1	01	01	H2012_060_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, Select Care Drugs												
H2012	060	0	1	01	01	H2012_060_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2012	060	0	1	01	01	H2012_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		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, Select Care Drugs										2	3	
H2012	060	0	1	01	01	H2012_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		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 Care Drugs										2	3	
H2012	060	0	1	01	01	H2012_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2012	060	0	1	01	01	H2012_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	060	0	1	01	01	H2012_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		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 Care Drugs												
H2012	060	0	1	01	01	H2012_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		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, Select Care Drugs												
H2012	060	0	1	01	01	H2012_060_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	060	0	1	01	01	H2012_060_0	5	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	060	0	1	01	01	H2012_060_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, Select Care Drugs										2	3	
H2012	064	0	1	01	01	H2012_064_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	064	0	1	01	01	H2012_064_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	064	0	1	01	01	H2012_064_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		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												
H2012	064	0	1	01	01	H2012_064_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		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												
H2012	064	0	1	01	01	H2012_064_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	070	0	1	01	01	H2012_070_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												
H2012	070	0	1	01	01	H2012_070_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	070	0	1	01	01	H2012_070_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H2012	070	0	1	01	01	H2012_070_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		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												
H2012	080	0	1	01	01	H2012_080_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		15.00				0.16	5.00		0.00				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	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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	080	0	1	01	01	H2012_080_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H2012	080	0	1	01	01	H2012_080_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		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										2	3	
H2012	080	0	1	01	01	H2012_080_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	080	0	1	01	01	H2012_080_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		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												
H2012	080	0	1	01	01	H2012_080_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		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												
H2012	080	0	1	01	01	H2012_080_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	081	0	1	01	01	H2012_081_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		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												
H2012	081	0	1	01	01	H2012_081_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		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												
H2012	081	0	1	01	01	H2012_081_0	3	2	Non-Preferred Generic	1	3	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												
H2012	081	0	1	01	01	H2012_081_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												
H2012	081	0	1	01	01	H2012_081_0	3	5	Specialty Tier	1	3	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												
H2012	082	0	1	01	01	H2012_082_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		15.00				0.16	5.00		0.00				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	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		30.00				0.33	10.00		0.00				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	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		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												
H2012	082	0	1	01	01	H2012_082_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		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												
H2012	082	0	1	01	01	H2012_082_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	082	0	1	01	01	H2012_082_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	082	0	1	01	01	H2012_082_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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H2012	082	0	1	01	01	H2012_082_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		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										2	3	
H2012	082	0	1	01	01	H2012_082_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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, Select Care Drugs										2	3	
H2012	084	0	1	01	01	H2012_084_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		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 Care Drugs										2	3	
H2012	084	0	1	01	01	H2012_084_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2012	084	0	1	01	01	H2012_084_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2012	084	0	1	01	01	H2012_084_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2012	084	0	1	01	01	H2012_084_0	3	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	084	0	1	01	01	H2012_084_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	084	0	1	01	01	H2012_084_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		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, Select Care Drugs												
H2012	084	0	1	01	01	H2012_084_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		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 Care Drugs												
H2012	084	0	1	01	01	H2012_084_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	084	0	1	01	01	H2012_084_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	087	0	1	01	01	H2012_087_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		54.00				0.60	18.00		0.00				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	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		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												
H2012	087	0	1	01	01	H2012_087_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		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												
H2012	087	0	1	01	01	H2012_087_0	3	5	Specialty Tier	1	4	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												
H2012	087	0	1	01	01	H2012_087_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		18.00				0.20	6.00		0.00				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	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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	087	0	1	01	01	H2012_087_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		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										2	3	
H2012	087	0	1	01	01	H2012_087_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		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										2	3	
H2012	087	0	1	01	01	H2012_087_0	3	5	Specialty Tier	3	4	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										2	3	
H2012	087	0	1	01	01	H2012_087_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	088	0	1	01	01	H2012_088_0	3	5	Specialty Tier	3	4	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										2	3	
H2012	088	0	1	01	01	H2012_088_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		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										2	3	
H2012	088	0	1	01	01	H2012_088_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		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										2	3	
H2012	088	0	1	01	01	H2012_088_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	088	0	1	01	01	H2012_088_0	3	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		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										2	3	
H2012	088	0	1	01	01	H2012_088_0	3	5	Specialty Tier	1	4	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												
H2012	088	0	1	01	01	H2012_088_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		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												
H2012	088	0	1	01	01	H2012_088_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		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												
H2012	088	0	1	01	01	H2012_088_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	088	0	1	01	01	H2012_088_0	3	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		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												
H2012	090	0	1	01	01	H2012_090_0	3	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		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												
H2012	090	0	1	01	01	H2012_090_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	090	0	1	01	01	H2012_090_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		21.00				0.23	7.00		0.00				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	3	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		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										2	3	
H2012	090	0	1	01	01	H2012_090_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		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										2	3	
H2012	090	0	1	01	01	H2012_090_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		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												
H2012	090	0	1	01	01	H2012_090_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		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												
H2012	090	0	1	01	01	H2012_090_0	3	5	Specialty Tier	3	4	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										2	3	
H2012	090	0	1	01	01	H2012_090_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		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										2	3	
H2012	090	0	1	01	01	H2012_090_0	3	5	Specialty Tier	1	4	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												
H2012	093	0	1	01	01	H2012_093_0	3	5	Specialty Tier	3	4	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										2	3	
H2012	093	0	1	01	01	H2012_093_0	3	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		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												
H2012	093	0	1	01	01	H2012_093_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		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										2	3	
H2012	093	0	1	01	01	H2012_093_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		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										2	3	
H2012	093	0	1	01	01	H2012_093_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	093	0	1	01	01	H2012_093_0	3	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		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										2	3	
H2012	093	0	1	01	01	H2012_093_0	3	5	Specialty Tier	1	4	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												
H2012	093	0	1	01	01	H2012_093_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	093	0	1	01	01	H2012_093_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		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												
H2012	093	0	1	01	01	H2012_093_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		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												
H2012	096	0	1	01	01	H2012_096_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				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	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	096	0	1	01	01	H2012_096_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		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										2	3	
H2012	096	0	1	01	01	H2012_096_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		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												
H2012	096	0	1	01	01	H2012_096_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	096	0	1	01	01	H2012_096_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_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		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												
H2012	096	0	1	01	01	H2012_096_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		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										2	3	
H2012	097	0	1	01	01	H2012_097_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	097	0	1	01	01	H2012_097_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		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										2	3	
H2012	097	0	1	01	01	H2012_097_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		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										2	3	
H2012	097	0	1	01	01	H2012_097_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	097	0	1	01	01	H2012_097_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	097	0	1	01	01	H2012_097_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		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												
H2012	097	0	1	01	01	H2012_097_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		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												
H2012	097	0	1	01	01	H2012_097_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	099	1	1	01	01	H2012_099_1	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	099	1	1	01	01	H2012_099_1	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	099	1	1	01	01	H2012_099_1	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		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												
H2012	099	1	1	01	01	H2012_099_1	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		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												
H2012	099	1	1	01	01	H2012_099_1	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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	099	1	1	01	01	H2012_099_1	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	099	1	1	01	01	H2012_099_1	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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	099	1	1	01	01	H2012_099_1	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		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										2	3	
H2012	099	1	1	01	01	H2012_099_1	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		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										2	3	
H2012	099	1	1	01	01	H2012_099_1	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	099	2	1	01	01	H2012_099_2	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		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										2	3	
H2012	099	2	1	01	01	H2012_099_2	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		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										2	3	
H2012	099	2	1	01	01	H2012_099_2	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	099	2	1	01	01	H2012_099_2	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	099	2	1	01	01	H2012_099_2	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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	099	2	1	01	01	H2012_099_2	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		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												
H2012	099	2	1	01	01	H2012_099_2	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		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												
H2012	099	2	1	01	01	H2012_099_2	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	099	2	1	01	01	H2012_099_2	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	099	2	1	01	01	H2012_099_2	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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	100	4	1	01	01	H2012_100_4	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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	100	4	1	01	01	H2012_100_4	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	100	4	1	01	01	H2012_100_4	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		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										2	3	
H2012	100	4	1	01	01	H2012_100_4	9	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	100	4	1	01	01	H2012_100_4	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		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										2	3	
H2012	100	4	1	01	01	H2012_100_4	9	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	4	1	01	01	H2012_100_4	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		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												
H2012	100	4	1	01	01	H2012_100_4	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		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												
H2012	100	4	1	01	01	H2012_100_4	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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	4	1	01	01	H2012_100_4	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	100	5	1	01	01	H2012_100_5	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		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										2	3	
H2012	100	5	1	01	01	H2012_100_5	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		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										2	3	
H2012	100	5	1	01	01	H2012_100_5	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	100	5	1	01	01	H2012_100_5	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	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		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												
H2012	100	5	1	01	01	H2012_100_5	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		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												
H2012	100	5	1	01	01	H2012_100_5	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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2029	001	0	1	04	01	H2029_001_0	7	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		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												
H2029	001	0	1	04	01	H2029_001_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		30.00				0.33	10.00		0.00				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	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		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												
H2029	001	0	1	04	01	H2029_001_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		270.00				3.00	90.00		260.00				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	7	5	Specialty Tier	3	4	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										2	3	
H2029	001	0	1	04	01	H2029_001_0	7	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		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										2	3	
H2029	001	0	1	04	01	H2029_001_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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H2029	001	0	1	04	01	H2029_001_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		270.00				3.00	90.00		260.00				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	7	5	Specialty Tier	1	4	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												
H2108	022	0	1	01	01	H2108_022_0	6	1	Preferred Generic	1	3	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		21.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	6	3	Preferred Brand	1	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	6	2	Non-Preferred Generic	1	3	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		45.00																		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	6	4	Non-Preferred Brand	1	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	6	5	Specialty Tier	1	3	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					399.27	26	26	26																					26		26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_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		135.00																		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	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		36.00																		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	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		21.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					599.60	26	26	26																					26		26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	5	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	029	0	1	01	01	H2108_029_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		21.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	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		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	5	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					534.76	26	26	26																					26		26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	5	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		15.00																		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	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		135.00																		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	5	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		45.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	5	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		30.00																		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	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		135.00																		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	5	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					588.67	26	26	26																					26		26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	5	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		24.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	032	0	1	01	01	H2108_032_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					540.31	26	26	26																					26		26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	032	0	1	01	01	H2108_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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	032	0	1	01	01	H2108_032_0	5	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	032	0	1	01	01	H2108_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		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	032	0	1	01	01	H2108_032_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		21.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2112	007	0	1	01	01	H2112_007_0	7	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.23	7.00	14.00	21.00																					0.23	7.00	14.00	21.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2112	007	0	1	01	01	H2112_007_0	7	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					45.58	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2112	007	0	1	01	01	H2112_007_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	.43	13.00	26.00	39.00																					.43	13.00	26.00	39.00																			13.00			.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2112	007	0	1	01	01	H2112_007_0	7	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2112	007	0	1	01	01	H2112_007_0	7	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2150	002	0	1	18	06	H2150_002_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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		80.00				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	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					.33	10.00		30.00												1.10	33.00		99.00				.33	10.00		20.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_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					.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												
H2150	002	0	1	18	06	H2150_002_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					2.50	75.00		225.00												3.16	95.00		285.00				2.50	75.00		150.00				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	7	5	Specialty Tier	1	4	100001	1	1		110	01		110	1				30		90	2				30		90	30		31													1031.00	33		33					1031.00	33		33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	7	1	Preferred Generic	3	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.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		
H2150	002	0	1	18	06	H2150_002_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				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	7	2	Non-Preferred Generic	3	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					.33	10.00		30.00												1.10	33.00		99.00				.33	10.00		20.00				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	7	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	009	0	1	18	06	H2150_009_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				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	7	5	Specialty Tier	1	3	100001	1	1		110	01		110	1				30		90	2				30		90	30		31													1048.00	33		33					1048.00	33		33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	7	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					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		180.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.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												
H2150	009	0	1	18	06	H2150_009_0	7	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		80.00				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	7	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					1.00	30.00		90.00												1.10	33.00		99.00				1.00	30.00		60.00				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	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.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												
H2150	029	0	2	18	06	H2150_029_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				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	7	5	Specialty Tier	1	3	100001	1	1		110	01		110	1				30		90	2				30		90	30		31													1060.00	33		33					1060.00	33		33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	7	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					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		180.00				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	7	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					.60	18.00		54.00												1.10	33.00		99.00				.60	18.00		36.00				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	7	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		80.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2161	002	0	1	01	01	H2161_002_0	7	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	7	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												
H2161	002	0	1	01	01	H2161_002_0	7	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	7	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	7	5	Specialty Tier	1	4	100000	1	1	010		01			1	30													30		31						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	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		9.00																		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		36.00																		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	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		135.00																		45.00				1.45	45.00		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		240.00																		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					255.20	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		9.00																		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		36.00																		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	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		240.00																		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	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		135.00																		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	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		36.00																		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	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		9.00																		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	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					247.93	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	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		9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2165	011	0	1	02	01	H2165_011_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		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2165	018	0	1	01	01	H2165_018_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		210.00																		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	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		105.00																		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	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		24.00																		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	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		9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					614.15	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2171	001	0	1	01	01	H2171_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												
H2171	001	0	1	01	01	H2171_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	0.27	8.00	16.00	20.00																					0.25	8.00	16.00	20.00																			8.00			0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	7	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	1.50	45.00	90.00	112.50																					1.45	45.00	90.00	112.50																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2171	001	0	1	01	01	H2171_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	3.17	95.00	190.00	237.50																					3.06	95.00	190.00	237.50																			95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2171	001	0	1	01	01	H2171_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												
H2171	001	0	1	01	01	H2171_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		
H2174	009	0	1	01	01	H2174_009_0	6	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	009	0	1	01	01	H2174_009_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.58	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	009	0	1	01	01	H2174_009_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	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2174	009	0	1	01	01	H2174_009_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	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2174	009	0	1	01	01	H2174_009_0	6	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												
H2230	002	0	1	04	01	H2230_002_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	2.00	2.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_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	0.20	6.00	12.00	18.00																					0.20	6.00	12.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	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	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	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	7	5	Specialty Tier	1	4	101101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31						28	28	28																					28	28	28																	28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	6	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	6	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	6	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	6	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	6	5	Specialty Tier	1	4	101101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31						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	6	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	6	5	Specialty Tier	1	4	101101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31						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	6	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	6	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	6	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	8	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	8	3	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31						25																							25																			25				25	Generic, Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	8	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	8	2	Brand	1	3	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.63	49.00	98.00	147.00																					1.63	49.00	98.00	147.00																		49.00				1.58	49.00		Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	8	1	Generic	1	3	010000	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		Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	8	3	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31						25																							25																			25				25	Generic, Brand, Specialty Tier												
H2241	003	1	1	01	01	H2241_003_1	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2241	003	1	1	01	01	H2241_003_1	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2241	003	1	1	01	01	H2241_003_1	9	5	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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	003	1	1	01	01	H2241_003_1	9	4	Non-Preferred Brand	1	4	100100	3	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	003	1	1	01	01	H2241_003_1	9	3	Preferred Brand	1	4	010001	3	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	003	1	1	01	01	H2241_003_1	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	003	1	1	01	01	H2241_003_1	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	003	2	1	01	01	H2241_003_2	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2241	003	2	1	01	01	H2241_003_2	8	4	Non-Preferred Brand	1	4	100100	3	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	003	2	1	01	01	H2241_003_2	8	3	Preferred Brand	1	4	010001	3	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	003	2	1	01	01	H2241_003_2	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	003	2	1	01	01	H2241_003_2	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	003	2	1	01	01	H2241_003_2	8	5	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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	003	2	1	01	01	H2241_003_2	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	1	1	01	01	H2256_001_1	13	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	13	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	13	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				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	13	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00	160.00	240.00																		80.00				2.25	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	13	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	13	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	13	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				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	2	1	01	01	H2256_001_2	13	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	13	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	13	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				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	13	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00	160.00	240.00																		80.00				2.25	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	13	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	13	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	13	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				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	6	1	01	01	H2256_001_6	13	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	13	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	13	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				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	6	1	01	01	H2256_001_6	13	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	13	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	13	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00	160.00	240.00																		80.00				2.25	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	13	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				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	13	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	1	1	01	01	H2256_015_1	13	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	015	1	1	01	01	H2256_015_1	13	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.45	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	015	1	1	01	01	H2256_015_1	13	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.26	8.00	16.00	24.00																					.23	7.00	14.00	21.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	13	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	015	2	1	01	01	H2256_015_2	13	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	015	2	1	01	01	H2256_015_2	13	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.26	8.00	16.00	24.00																					.23	7.00	14.00	21.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	13	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.45	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	015	2	1	01	01	H2256_015_2	13	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	13	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	015	6	1	01	01	H2256_015_6	13	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	015	6	1	01	01	H2256_015_6	13	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.26	8.00	16.00	24.00																					.23	7.00	14.00	21.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	13	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.45	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	015	6	1	01	01	H2256_015_6	13	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	015	6	1	01	01	H2256_015_6	13	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	14	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.45	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	018	1	1	01	01	H2256_018_1	14	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	018	1	1	01	01	H2256_018_1	14	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.26	8.00	16.00	24.00																					.23	7.00	14.00	21.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	1	1	01	01	H2256_018_1	14	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	018	1	1	01	01	H2256_018_1	14	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	14	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	018	7	1	01	01	H2256_018_7	14	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.26	8.00	16.00	24.00																					.23	7.00	14.00	21.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	7	1	01	01	H2256_018_7	14	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.45	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	018	7	1	01	01	H2256_018_7	14	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	018	7	1	01	01	H2256_018_7	14	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	14	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.26	8.00	16.00	24.00																					.23	7.00	14.00	21.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	8	1	01	01	H2256_018_8	14	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	018	8	1	01	01	H2256_018_8	14	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.45	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	018	8	1	01	01	H2256_018_8	14	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	14	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	026	1	1	01	01	H2256_026_1	14	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	026	1	1	01	01	H2256_026_1	14	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.26	8.00	16.00	24.00																					.23	7.00	14.00	21.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	1	1	01	01	H2256_026_1	14	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	026	1	1	01	01	H2256_026_1	14	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	026	1	1	01	01	H2256_026_1	14	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	29	29	29																					29	29	29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	2	1	01	01	H2256_026_2	14	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	026	2	1	01	01	H2256_026_2	14	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.26	8.00	16.00	24.00																					.23	7.00	14.00	21.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	2	1	01	01	H2256_026_2	14	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	026	2	1	01	01	H2256_026_2	14	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	026	2	1	01	01	H2256_026_2	14	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	29	29	29																					29	29	29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	3	1	01	01	H2256_026_3	14	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	026	3	1	01	01	H2256_026_3	14	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	026	3	1	01	01	H2256_026_3	14	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.26	8.00	16.00	24.00																					.23	7.00	14.00	21.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	3	1	01	01	H2256_026_3	14	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	026	3	1	01	01	H2256_026_3	14	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	29	29	29																					29	29	29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	13	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	13	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	13	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.40	12.00	24.00	36.00																					.33	10.00	20.00	30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	13	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																					.16	5.00	10.00	15.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	13	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	28	28	28																					28	28	28																	28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	13	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	13	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				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	13	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	033	0	1	01	01	H2256_033_0	13	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.16	65.00	130.00	195.00																					2.16	65.00	130.00	195.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	13	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	034	0	1	01	01	H2256_034_0	13	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.16	65.00	130.00	195.00																					2.16	65.00	130.00	195.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	13	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	034	0	1	01	01	H2256_034_0	13	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				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	13	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	13	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	14	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	14	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	14	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	036	0	1	01	01	H2256_036_0	14	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.16	65.00	130.00	195.00																					2.16	65.00	130.00	195.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	036	0	1	01	01	H2256_036_0	14	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	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	8	2	Non-Preferred Generic	1	4	000100	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	12.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.06	2.00	4.00	6.00																					.06	2.00	2.00	2.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_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												
H2261	005	0	1	01	01	H2261_005_0	8	5	Specialty Tier	1	4	101101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31						28	28	28																					28	28	28																	28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_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												
H2261	019	0	1	01	01	H2261_019_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	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	019	0	1	01	01	H2261_019_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	019	0	1	01	01	H2261_019_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	019	0	1	01	01	H2261_019_0	9	5	Specialty Tier	1	4	101101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31						25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	004	0	1	01	01	H2312_004_0	12	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.06	2.00	4.00	5.00																					.06	2.00	4.00	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	12	2	Non-Preferred Generic	1	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.48	15.00	30.00	37.50																					.48	15.00	30.00	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	12	3	Preferred Brand	1	4	000001	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.45	45.00	90.00	112.50																					1.45	45.00	90.00	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	004	0	1	01	01	H2312_004_0	12	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					74.98	28	28	28																					28	28	28																	28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	004	0	1	01	01	H2312_004_0	12	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1709.46	28	28	28																					28	28	28																	28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	007	0	1	02	01	H2312_007_0	10	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.06	2.00	4.00	5.00																					.06	2.00	4.00	5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	007	0	1	02	01	H2312_007_0	10	2	Non-Preferred Generic	1	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.48	15.00	30.00	37.50																					.48	15.00	30.00	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	10	3	Preferred Brand	1	4	000001	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.45	45.00	90.00	112.50																					1.45	45.00	90.00	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	007	0	1	02	01	H2312_007_0	10	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					75.87	30	30	30																					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	10	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1803.61	30	30	30																					30	30	30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	010	0	1	02	01	H2312_010_0	11	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.12	4.00	8.00	10.00																					.12	4.00	8.00	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	11	2	Non-Preferred Generic	3	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.32	10.00	20.00	25.00																					.32	10.00	20.00	25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		1
H2312	010	0	1	02	01	H2312_010_0	11	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.12	4.00	8.00	10.00																					.12	4.00	8.00	10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		1
H2312	010	0	1	02	01	H2312_010_0	11	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					3276.73	31	31	31																					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	11	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					81.86	31	31	31																					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	11	2	Non-Preferred Generic	1	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.32	10.00	20.00	25.00																					.32	10.00	20.00	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	11	3	Preferred Brand	1	4	000001	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.45	45.00	90.00	112.50																					1.45	45.00	90.00	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	012	0	1	02	01	H2312_012_0	10	2	Non-Preferred Generic	1	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.32	10.00	20.00	25.00																					.32	10.00	20.00	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	10	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.19	6.00	12.00	15.00																					.19	6.00	12.00	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	10	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					91.84	33	33	33																					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	10	3	Preferred Brand	1	4	000001	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.45	45.00	90.00	112.50																					1.45	45.00	90.00	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	012	0	1	02	01	H2312_012_0	10	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					2391.70	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	7	4	Non-Preferred Brand	1	4	110000	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	212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	7	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												
H2320	007	0	1	02	01	H2320_007_0	7	2	Non-Preferred Generic	1	4	000110	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	25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	7	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	8.00	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					468.02	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	5	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	8.00	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	5	2	Non-Preferred Generic	1	4	000110	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	25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	5	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												
H2320	008	0	1	02	01	H2320_008_0	5	4	Non-Preferred Brand	1	4	110000	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	212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					535.95	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	7	4	Non-Preferred Brand	1	4	110000	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	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_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	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	7	2	Non-Preferred Generic	1	4	000110	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	30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	7	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	15.00																					.16	5.00	10.00	12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					532.68	31																							31																			31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	7	2	Non-Preferred Generic	1	4	000110	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	30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	7	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	15.00																					.16	5.00	10.00	12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_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	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	7	4	Non-Preferred Brand	1	4	110000	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	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					569.94	31																							31																			31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	013	0	1	02	01	H2320_013_0	5	2	Non-Preferred Generic	1	4	000110	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	25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	013	0	1	02	01	H2320_013_0	5	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	8.00	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	013	0	1	02	01	H2320_013_0	5	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												
H2320	013	0	1	02	01	H2320_013_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					474.60	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	013	0	1	02	01	H2320_013_0	5	4	Non-Preferred Brand	1	4	110000	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	212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	6	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	15.00																					.16	5.00	10.00	12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	6	2	Non-Preferred Generic	1	4	000110	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	30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	6	4	Non-Preferred Brand	1	4	110000	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	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	6	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	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					544.84	31																							31																			31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	016	0	1	02	01	H2320_016_0	6	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	8.00	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	016	0	1	02	01	H2320_016_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					459.71	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	016	0	1	02	01	H2320_016_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	016	0	1	02	01	H2320_016_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												
H2320	016	0	1	02	01	H2320_016_0	6	2	Non-Preferred Generic	1	4	000110	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	25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	6	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	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	6	2	Non-Preferred Generic	1	4	000110	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	30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	6	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	15.00																					.16	5.00	10.00	12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	6	4	Non-Preferred Brand	1	4	110000	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	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					415.93	31																							31																			31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	019	0	1	02	01	H2320_019_0	5	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	8.00	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	019	0	1	02	01	H2320_019_0	5	2	Non-Preferred Generic	1	4	000110	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	25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	019	0	1	02	01	H2320_019_0	5	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												
H2320	019	0	1	02	01	H2320_019_0	5	4	Non-Preferred Brand	1	4	110000	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	212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	019	0	1	02	01	H2320_019_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					324.17	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	6	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	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	6	2	Non-Preferred Generic	1	4	000110	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	30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	6	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	15.00																					.16	5.00	10.00	12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	6	4	Non-Preferred Brand	1	4	110000	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	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					643.24	31																							31																			31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	9	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.12	4.00	8.00	10.00																					.12	4.00	8.00	10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	9	2	Non-Preferred Generic	1	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.32	10.00	20.00	25.00																					.32	10.00	20.00	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	9	3	Preferred Brand	1	4	000001	3	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, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	9	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					71.91	29	29	29																					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	9	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1769.41	29	29	29																					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	9	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.12	4.00	8.00	10.00																					.12	4.00	8.00	10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		1
H2322	004	0	1	04	01	H2322_004_0	9	2	Non-Preferred Generic	3	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.32	10.00	20.00	25.00																					.32	10.00	20.00	25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		1
H2322	008	0	1	04	01	H2322_008_0	9	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					74.72	33	33	33																					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	9	3	Preferred Brand	1	4	000001	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.45	45.00	90.00	112.50																					1.45	45.00	90.00	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	9	2	Non-Preferred Generic	1	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.48	15.00	30.00	37.50																					.48	15.00	30.00	37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	9	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.06	2.00	4.00	5.00																					.06	2.00	4.00	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	9	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1769.41	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2323	011	0	1	01	01	H2323_011_0	13	3	Specialty Tier	1	2	001001	1	1	110		01	110		1	30		90				2	30		90				30		31					100.00	25		25																					10		25																	25				25	Preferred Generic, Preferred Brand, Specialty Tier												
H2323	011	0	1	01	01	H2323_011_0	13	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.13	4.00		8.00																					0.12	4.00		8.00																		4.00				0.12	4.00		Preferred Generic, Preferred Brand, Specialty Tier												
H2323	011	0	1	01	01	H2323_011_0	13	2	Preferred Brand	1	2	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.17	35.00		70.00																					1.12	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Preferred Brand, Specialty Tier												
H2323	015	0	1	01	01	H2323_015_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.45	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	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.58	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	8	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	8	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.32	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	6	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	6	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	6	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												
H2323	016	0	1	01	01	H2323_016_0	6	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	6	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		
H2354	001	0	1	01	01	H2354_001_0	6	3	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.17	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	01	01	H2354_001_0	6	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	01	01	H2354_001_0	6	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	001	0	1	01	01	H2354_001_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	01	01	H2354_013_0	8	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	01	01	H2354_013_0	8	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	013	0	1	01	01	H2354_013_0	8	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	01	01	H2354_013_0	8	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	015	0	1	01	01	H2354_015_0	7	1	Generic	1	4	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												
H2354	015	0	1	01	01	H2354_015_0	7	2	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	112.50																					1.50	45.00	90.00	112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_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	015	0	1	01	01	H2354_015_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	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	4	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	4	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		93				1			93				31		31	0.93	29.00		87.00																								87.00																		29.00				0.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	4	1	Preferred Generic	1	4	001000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	4	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		93				1			93				31		31					385.62	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	4	1	Preferred Generic	1	4	001000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	4	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		93				1			93				31		31	0.93	29.00		87.00																								87.00																		29.00				0.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	4	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	4	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		93				1			93				31		31					498.30	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	4	1	Preferred Generic	1	4	001000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		93				1			93				31		31	0.93	29.00		87.00																								87.00																		29.00				0.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	4	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	4	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	4	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		93				1			93				31		31					460.71	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		10	100		1	30		90				2			90					29	31	.67	20.00		50.00																								40.00																			20.00			.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2459	002	0	1	02	01	H2459_002_0	7	1	Preferred Generic	3	4	001000	1	2	110		10	100		1	30		90				2			90					29	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										1		
H2459	002	0	1	02	01	H2459_002_0	7	5	Specialty Tier	1	4	010010	1	1	110		10	100		1	30		90				2			90					29	31					1203.65	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	7	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				2			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	7	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				2			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	7	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				2			90					29	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												
H2459	002	0	1	02	01	H2459_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		10	100		1	30		90				2			90					29	31	.67	20.00		50.00																								40.00																			20.00			.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	7	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				2			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	7	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				2			90					29	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												
H2459	013	0	1	02	01	H2459_013_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		10	100		1	30		90				2			90					29	31	.67	20.00		50.00																								40.00																			20.00			.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				2			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	7	5	Specialty Tier	1	4	010010	1	1	110		10	100		1	30		90				2			90					29	31					1414.23	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	7	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				2			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	7	2	Non-Preferred Generic	1	4	000100	1	2	110		10	100		1	30		90				2			90					29	31	.93	28.00		84.00																								56.00																			28.00			.90	28.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	7	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				2			90					29	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												
H2459	019	0	1	02	01	H2459_019_0	7	5	Specialty Tier	1	4	010010	1	1	110		10	100		1	30		90				2			90					29	31					1411.49	31		31																							31																		31			31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				2			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												
H2461	008	0	1	18	06	H2461_008_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																					1.12	35.00	70.00	70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2461	008	0	1	18	06	H2461_008_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.35	11.00	22.00	33.00																					.35	11.00	22.00	22.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2461	008	0	1	18	06	H2461_008_0	4	1	Preferred Generic	1	2	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												
H2461	008	0	1	18	06	H2461_008_0	4	4	Non-Preferred Brand	1	2	100000	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31					47.31	45	45	45																					45	45	45																	45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2461	009	0	1	18	06	H2461_009_0	4	4	Non-Preferred Brand	1	4	110000	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31					38.89	45	45	45																					45	45	45																	45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2461	009	0	1	18	06	H2461_009_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.12	4.00	8.00	12.00																					0.12	4.00	8.00	8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2461	009	0	1	18	06	H2461_009_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	28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2461	009	0	1	18	06	H2461_009_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												
H2461	010	0	1	18	06	H2461_010_0	4	4	Non-Preferred Brand	1	4	110000	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31					38.89	45	45	45																					45	45	45																	45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2461	010	0	1	18	06	H2461_010_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.12	4.00	8.00	12.00																					0.12	4.00	8.00	8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2461	010	0	1	18	06	H2461_010_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	28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2461	010	0	1	18	06	H2461_010_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												
H2462	008	0	1	18	06	H2462_008_0	8	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		285.00				3.17	95.00		190.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_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		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												
H2462	008	0	1	18	06	H2462_008_0	8	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		45.00				0.50	15.00		30.00				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	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					590.77	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	8	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		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												
H2462	011	0	1	18	06	H2462_011_0	5	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		15.00				0.17	5.00		10.00				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	5	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		45.00				0.50	15.00		30.00				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	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					561.90	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	011	0	1	18	06	H2462_011_0	5	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		285.00				3.17	95.00		190.00				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	5	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		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												
H2462	012	0	1	18	06	H2462_012_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		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												
H2462	012	0	1	18	06	H2462_012_0	5	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		36.00				0.40	12.00		24.00				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	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		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												
H2462	012	0	1	18	06	H2462_012_0	5	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		195.00				2.17	65.00		130.00				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	5	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		36.00				0.40	12.00		24.00				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	5	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		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		
H2462	012	0	1	18	06	H2462_012_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					903.82	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	5	3	Preferred Brand	3	4	000001	1	1	110		01		110	1	30		90				1				30		90	30		31					108.60	40		40																												45		45					40		40			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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		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												
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		60.00				.67	20.00		40.00				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		15.00				0.17	5.00		10.00				5.00				.16	5.00		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		285.00				3.17	95.00		190.00				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					512.87	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	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	3	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		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												
H2486	003	0	1	01	01	H2486_003_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		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												
H2486	003	0	1	01	01	H2486_003_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		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												
H2486	003	0	1	01	01	H2486_003_0	3	5	Specialty Tier	3	4	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										2	3	
H2486	003	0	1	01	01	H2486_003_0	3	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		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										2	3	
H2486	003	0	1	01	01	H2486_003_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2486	003	0	1	01	01	H2486_003_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		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										2	3	
H2486	003	0	1	01	01	H2486_003_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		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										2	3	
H2486	003	0	1	01	01	H2486_003_0	3	5	Specialty Tier	1	4	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												
H2491	002	0	1	02	01	H2491_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									1.00	30.00		90.00					0.50	15.00		45.00												1.00	30.00		90.00				0.50	15.00		37.50				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	002	0	1	02	01	H2491_002_0	7	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.26	8.00		24.00					0.10	3.00		9.00												0.26	8.00		24.00				0.10	3.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	002	0	1	02	01	H2491_002_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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	7	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.60	78.00		234.00												3.16	95.00		285.00				2.60	78.00		195.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	02	01	H2491_004_0	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	02	01	H2491_004_0	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.46	14.00		42.00					.06	2.00		6.00												.46	14.00		42.00				.06	2.00		5.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	02	01	H2491_004_0	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					.83	25.00		75.00												1.50	45.00		135.00				.83	25.00		62.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	02	01	H2491_004_0	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.60	78.00		234.00												3.16	95.00		285.00				2.60	78.00		195.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	02	01	H2491_004_0	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	005	0	1	02	01	H2491_005_0	7	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.33	10.00		30.00					0.16	5.00		15.00												0.33	10.00		30.00				0.16	5.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	005	0	1	02	01	H2491_005_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									1.00	30.00		90.00					0.50	15.00		45.00												1.00	30.00		90.00				0.50	15.00		37.50				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	005	0	1	02	01	H2491_005_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.80	84.00		252.00												3.16	95.00		285.00				2.80	84.00		210.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	005	0	1	02	01	H2491_005_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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	005	0	1	02	01	H2491_005_0	7	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2506	001	0	1	48	05	H2506_001_0	2	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/OTC 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	2	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/OTC 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	2	3	Non-Medicare Rx/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/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	5	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	0.00	2.65	0.00	2.65	0.00	2.65	0.00	2.65			
H2531	001	0	1	48	05	H2531_001_0	5	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	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
H2531	001	0	1	48	05	H2531_001_0	5	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			
H2533	001	0	1	48	05	H2533_001_0	3	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		01	010		1	31							31						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			
H2533	001	0	1	48	05	H2533_001_0	3	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/OTC Drugs	1	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
H2533	001	0	1	48	05	H2533_001_0	3	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/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2563	001	0	1	01	01	H2563_001_0	9	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	9	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	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		34					422.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	9	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	9	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	002	0	1	01	01	H2563_002_0	9	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	9	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	9	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	9	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	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		34					420.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2591	001	0	1	04	01	H2591_001_0	3	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												
H2591	001	0	1	04	01	H2591_001_0	3	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												
H2591	001	0	1	04	01	H2591_001_0	3	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	32		32					1.00	32		32					32		32																	32				32	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2591	001	0	1	04	01	H2591_001_0	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.26	8.00		24.00					0.00	0.00		0.00					.26	8.00		24.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2591	001	0	1	04	01	H2591_001_0	3	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					1.10	33.00		99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2593	001	0	1	01	01	H2593_001_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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	8	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	001	0	1	01	01	H2593_001_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H2593	001	0	1	01	01	H2593_001_0	8	6	Select Care Drugs	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																		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	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	8	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					2.74	85.00		255.00								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	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_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, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.24	7.50		22.50																								18.75																		7.50				.24	7.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6	6	Select Care Drugs	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	003	0	1	01	01	H2593_003_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.24	7.50		22.50																								18.75																		7.50				.24	7.50		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	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		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	6	6	Select Care Drugs	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					491.00	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	6	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												
H2593	003	0	1	01	01	H2593_003_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																								100.00																		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	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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	6	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					2.74	85.00		255.00								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	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	005	0	1	01	01	H2593_005_0	6	6	Select Care Drugs	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																		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	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H2593	005	0	1	01	01	H2593_005_0	6	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	6	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					2.74	85.00		255.00								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	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	6	6	Select Care Drugs	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																		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	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H2593	006	0	1	01	01	H2593_006_0	6	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	006	0	1	01	01	H2593_006_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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	007	0	1	01	01	H2593_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					2.74	85.00		255.00								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	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					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	007	0	1	01	01	H2593_007_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	007	0	1	01	01	H2593_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					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, Select Care Drugs												
H2593	007	0	1	01	01	H2593_007_0	9	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	007	0	1	01	01	H2593_007_0	9	6	Select Care Drugs	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																		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	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H2593	007	0	1	01	01	H2593_007_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	6	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					2.74	85.00		255.00								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	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	011	0	1	01	01	H2593_011_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	011	0	1	01	01	H2593_011_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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	011	0	1	01	01	H2593_011_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	011	0	1	01	01	H2593_011_0	6	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H2593	011	0	1	01	01	H2593_011_0	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	6	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					2.74	85.00		255.00								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	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	013	0	1	01	01	H2593_013_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H2593	013	0	1	01	01	H2593_013_0	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	6	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	014	0	1	01	01	H2593_014_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	014	0	1	01	01	H2593_014_0	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	014	0	1	01	01	H2593_014_0	6	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H2593	014	0	1	01	01	H2593_014_0	6	6	Select Care Drugs	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																		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	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	6	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					2.74	85.00		255.00								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	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	015	0	1	01	01	H2593_015_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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	015	0	1	01	01	H2593_015_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	015	0	1	01	01	H2593_015_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	015	0	1	01	01	H2593_015_0	6	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					2.74	85.00		255.00								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	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	015	0	1	01	01	H2593_015_0	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	015	0	1	01	01	H2593_015_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H2593	015	0	1	01	01	H2593_015_0	6	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.32	10.00		30.00					0.16	5.00		15.00								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	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.50	15.50		46.50					.33	10.50		31.50								26.25																		15.50				.50	15.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	016	0	1	01	01	H2593_016_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	6	6	Select Care Drugs	1	4	010010	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	6	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					2.90	90.00		270.00								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	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								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	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								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									3.06	95.00		285.00					2.90	90.00		270.00								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													491.00	33							491.00	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	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.32	10.00		30.00					0.16	5.00		15.00								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									.50	15.50		46.50					.33	10.50		31.50								26.25																		15.50				.50	15.50		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	010010	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	9	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					0.00	0.00	0.00	0.00					.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	9	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									.16	5.00	10.00	15.00					0.00	0.00	0.00	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												
H2610	005	0	1	01	01	H2610_005_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													2379.72	33							2379.72	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	005	0	1	01	01	H2610_005_0	9	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					2.09	65.00	130.00	195.00					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	9	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									1.25	39.00	78.00	117.00					1.09	34.00	68.00	102.00					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	006	0	1	01	01	H2610_006_0	9	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					0.00	0.00	0.00	0.00					.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	9	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									.16	5.00	10.00	15.00					0.00	0.00	0.00	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												
H2610	006	0	1	01	01	H2610_006_0	9	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					.93	29.00	58.00	87.00					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	9	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					1.77	55.00	110.00	165.00					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	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													2038.90	33							2038.90	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	9	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00					.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	9	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									.16	5.00	10.00	15.00					0.00	0.00	0.00	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										1		
H2610	011	0	1	01	01	H2610_011_0	11	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									2.74	85.00	170.00	255.00					2.41	75.00	150.00	225.00					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	11	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									1.35	42.00	84.00	126.00					1.19	37.00	74.00	111.00					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	11	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					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												
H2610	011	0	1	01	01	H2610_011_0	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									.22	7.00	14.00	21.00					0.00	0.00	0.00	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												
H2610	011	0	1	01	01	H2610_011_0	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1955.77	33							1955.77	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	8	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					0.00	0.00	0.00	0.00					.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	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									.16	5.00	10.00	15.00					0.00	0.00	0.00	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												
H2610	014	0	1	02	01	H2610_014_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									1.25	39.00	78.00	117.00					1.09	34.00	68.00	102.00					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	014	0	1	02	01	H2610_014_0	8	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					2.09	65.00	130.00	195.00					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	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													2962.00	33							2962.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	015	0	1	01	01	H2610_015_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	2.96	92.00	184.00	276.00																					2.96	92.00	184.00	276.00																		92.00				2.96	92.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	015	0	1	01	01	H2610_015_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	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	015	0	1	01	01	H2610_015_0	9	2	Non-Preferred Generic	1	4	000100	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												
H2610	015	0	1	01	01	H2610_015_0	9	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																					.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	015	0	1	01	01	H2610_015_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					2407.38	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	001	0	1	04	01	H2611_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.26	8.00	16.00	24.00																					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												
H2611	001	0	1	04	01	H2611_001_0	6	1	Preferred Generic	1	4	001000	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												
H2611	001	0	1	04	01	H2611_001_0	6	3	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	135.00																			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	6	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					44.70	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	001	0	1	04	01	H2611_001_0	6	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	008	0	1	04	01	H2611_008_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.50	15.00	30.00	45.00					.33	10.00	20.00	30.00					.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	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	30.00					.20	6.00	12.00	18.00					.20	6.00	12.00	18.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	008	0	1	04	01	H2611_008_0	3	3	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	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												
H2611	008	0	1	04	01	H2611_008_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	008	0	1	04	01	H2611_008_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													41.50	50	50	50					36.59	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	018	0	1	04	01	H2611_018_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	15.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	018	0	1	04	01	H2611_018_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.66	20.00	40.00	60.00					.50	15.00	30.00	45.00					.50	15.00	30.00	45.00																			20.00			.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	018	0	1	04	01	H2611_018_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													44.58	50	50	50					40.96	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	018	0	1	04	01	H2611_018_0	3	3	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	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												
H2611	018	0	1	04	01	H2611_018_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	004	0	1	01	01	H2649_004_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		15.00				0.16	5.00		0.00				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	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		30.00				0.33	10.00		0.00				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	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		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												
H2649	004	0	1	01	01	H2649_004_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		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												
H2649	004	0	1	01	01	H2649_004_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	004	0	1	01	01	H2649_004_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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H2649	004	0	1	01	01	H2649_004_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		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										2	3	
H2649	004	0	1	01	01	H2649_004_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	020	0	1	01	01	H2649_020_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		30.00				0.33	10.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	020	0	1	01	01	H2649_020_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H2649	020	0	1	01	01	H2649_020_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		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												
H2649	020	0	1	01	01	H2649_020_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		30.00				0.33	10.00		0.00				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	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		15.00				0.16	5.00		0.00				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	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		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										2	3	
H2649	020	0	1	01	01	H2649_020_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		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										2	3	
H2649	021	0	1	01	01	H2649_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		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												
H2649	021	0	1	01	01	H2649_021_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	021	0	1	01	01	H2649_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		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										2	3	
H2649	021	0	1	01	01	H2649_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		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										2	3	
H2649	021	0	1	01	01	H2649_021_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	021	0	1	01	01	H2649_021_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	021	0	1	01	01	H2649_021_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	021	0	1	01	01	H2649_021_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	021	0	1	01	01	H2649_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		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												
H2649	021	0	1	01	01	H2649_021_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		30.00				0.33	10.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	023	0	1	01	01	H2649_023_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		30.00				0.33	10.00		0.00				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	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		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												
H2649	023	0	1	01	01	H2649_023_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		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										2	3	
H2649	023	0	1	01	01	H2649_023_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		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										2	3	
H2649	023	0	1	01	01	H2649_023_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		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												
H2649	023	0	1	01	01	H2649_023_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		30.00				0.33	10.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	024	0	1	01	01	H2649_024_0	5	5	Specialty Tier	3	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	024	0	1	01	01	H2649_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					0.03	1.00		3.00												0.20	6.00		18.00				0.03	1.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	024	0	1	01	01	H2649_024_0	5	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					0.10	3.00		9.00												0.30	9.00		27.00				0.10	3.00		0.00				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	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		110.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	024	0	1	01	01	H2649_024_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	024	0	1	01	01	H2649_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					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		260.00				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	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		110.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	024	0	1	01	01	H2649_024_0	5	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					0.10	3.00		9.00												0.30	9.00		27.00				0.10	3.00		0.00				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	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					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		260.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H2649	025	0	1	01	01	H2649_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		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										2	3	
H2649	025	0	1	01	01	H2649_025_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	025	0	1	01	01	H2649_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	025	0	1	01	01	H2649_025_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		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												
H2649	025	0	1	01	01	H2649_025_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H2649	025	0	1	01	01	H2649_025_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		30.00				0.33	10.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	029	0	1	01	01	H2649_029_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	029	0	1	01	01	H2649_029_0	3	5	Specialty Tier	1	4	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												
H2649	029	0	1	01	01	H2649_029_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		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												
H2649	029	0	1	01	01	H2649_029_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		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												
H2649	029	0	1	01	01	H2649_029_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		12.00				0.13	4.00		0.00				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	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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H2649	029	0	1	01	01	H2649_029_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		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										2	3	
H2649	029	0	1	01	01	H2649_029_0	3	5	Specialty Tier	3	4	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										2	3	
H2649	029	0	1	01	01	H2649_029_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		30.00				0.33	10.00		0.00				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	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		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												
H2649	030	0	1	02	01	H2649_030_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		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												
H2649	030	0	1	02	01	H2649_030_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	030	0	1	02	01	H2649_030_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	030	0	1	02	01	H2649_030_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	030	0	1	02	01	H2649_030_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	030	0	1	02	01	H2649_030_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	030	0	1	02	01	H2649_030_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		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										2	3	
H2649	030	0	1	02	01	H2649_030_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		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										2	3	
H2649	030	0	1	02	01	H2649_030_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_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		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												
H2649	031	0	1	01	01	H2649_031_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		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												
H2649	031	0	1	01	01	H2649_031_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H2649	031	0	1	01	01	H2649_031_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		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										2	3	
H2649	031	0	1	01	01	H2649_031_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	031	0	1	01	01	H2649_031_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	032	0	1	01	01	H2649_032_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	032	0	1	01	01	H2649_032_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	032	0	1	01	01	H2649_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		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												
H2649	032	0	1	01	01	H2649_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		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												
H2649	032	0	1	01	01	H2649_032_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H2649	032	0	1	01	01	H2649_032_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	032	0	1	01	01	H2649_032_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	032	0	1	01	01	H2649_032_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H2649	033	0	1	01	01	H2649_033_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	033	0	1	01	01	H2649_033_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	033	0	1	01	01	H2649_033_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		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												
H2649	033	0	1	01	01	H2649_033_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		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												
H2649	033	0	1	01	01	H2649_033_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	033	0	1	01	01	H2649_033_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	033	0	1	01	01	H2649_033_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		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										2	3	
H2649	033	0	1	01	01	H2649_033_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		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										2	3	
H2649	034	0	1	01	01	H2649_034_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	034	0	1	01	01	H2649_034_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	034	0	1	01	01	H2649_034_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		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												
H2649	034	0	1	01	01	H2649_034_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		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												
H2649	034	0	1	01	01	H2649_034_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		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										2	3	
H2649	034	0	1	01	01	H2649_034_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	034	0	1	01	01	H2649_034_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	034	0	1	01	01	H2649_034_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		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										2	3	
H2649	034	0	1	01	01	H2649_034_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H2649	035	0	1	01	01	H2649_035_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		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										2	3	
H2649	035	0	1	01	01	H2649_035_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	035	0	1	01	01	H2649_035_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	035	0	1	01	01	H2649_035_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H2649	035	0	1	01	01	H2649_035_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		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												
H2649	035	0	1	01	01	H2649_035_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	035	0	1	01	01	H2649_035_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	036	0	1	01	01	H2649_036_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		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, Select Care Drugs										2	3	
H2649	036	0	1	01	01	H2649_036_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		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 Care Drugs										2	3	
H2649	036	0	1	01	01	H2649_036_0	3	6	Select Care Drugs	3	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2649	036	0	1	01	01	H2649_036_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2649	036	0	1	01	01	H2649_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2649	036	0	1	01	01	H2649_036_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2649	036	0	1	01	01	H2649_036_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		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 Care Drugs												
H2649	036	0	1	01	01	H2649_036_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		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, Select Care Drugs												
H2649	036	0	1	01	01	H2649_036_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2649	036	0	1	01	01	H2649_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2649	036	0	1	01	01	H2649_036_0	3	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2649	036	0	1	01	01	H2649_036_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2649	039	0	1	01	01	H2649_039_0	3	5	Specialty Tier	1	3	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												
H2649	039	0	1	01	01	H2649_039_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		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												
H2649	039	0	1	01	01	H2649_039_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		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												
H2649	039	0	1	01	01	H2649_039_0	3	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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	039	0	1	01	01	H2649_039_0	3	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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	040	0	1	01	01	H2649_040_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		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												
H2649	040	0	1	01	01	H2649_040_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		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												
H2649	040	0	1	01	01	H2649_040_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	040	0	1	01	01	H2649_040_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	040	0	1	01	01	H2649_040_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	040	0	1	01	01	H2649_040_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	040	0	1	01	01	H2649_040_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	040	0	1	01	01	H2649_040_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		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										2	3	
H2649	040	0	1	01	01	H2649_040_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		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										2	3	
H2649	040	0	1	01	01	H2649_040_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	041	0	1	01	01	H2649_041_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		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												
H2649	041	0	1	01	01	H2649_041_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		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												
H2649	041	0	1	01	01	H2649_041_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	041	0	1	01	01	H2649_041_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	041	0	1	01	01	H2649_041_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	041	0	1	01	01	H2649_041_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H2649	041	0	1	01	01	H2649_041_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		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										2	3	
H2649	041	0	1	01	01	H2649_041_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	041	0	1	01	01	H2649_041_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	042	0	1	01	01	H2649_042_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																												0.06	2.00		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												
H2649	042	0	1	01	01	H2649_042_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	042	0	1	01	01	H2649_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		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												
H2649	042	0	1	01	01	H2649_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		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												
H2649	042	0	1	01	01	H2649_042_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	042	0	1	01	01	H2649_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		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										2	3	
H2649	042	0	1	01	01	H2649_042_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	042	0	1	01	01	H2649_042_0	3	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		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										2	3	
H2649	042	0	1	01	01	H2649_042_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	042	0	1	01	01	H2649_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		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										2	3	
H2649	043	0	1	01	01	H2649_043_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	043	0	1	01	01	H2649_043_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	043	0	1	01	01	H2649_043_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		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												
H2649	043	0	1	01	01	H2649_043_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		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												
H2649	043	0	1	01	01	H2649_043_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	043	0	1	01	01	H2649_043_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	043	0	1	01	01	H2649_043_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	043	0	1	01	01	H2649_043_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		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										2	3	
H2649	043	0	1	01	01	H2649_043_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		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										2	3	
H2649	043	0	1	01	01	H2649_043_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2654	010	0	1	01	01	H2654_010_0	2	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																															24.00							16.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	010	0	1	01	01	H2654_010_0	2	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							125.00				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	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	010	0	1	01	01	H2654_010_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					778.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	01	01	H2654_013_0	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	01	01	H2654_013_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	01	01	H2654_013_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	01	01	H2654_013_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					690.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	01	01	H2654_013_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	033	0	1	01	01	H2654_033_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	033	0	1	01	01	H2654_033_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																															30.00							20.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	033	0	1	01	01	H2654_033_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	033	0	1	01	01	H2654_033_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	033	0	1	01	01	H2654_033_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					707.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	002	0	1	01	01	H2663_002_0	6	1	Preferred Generic	1	4	001000	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												
H2663	002	0	1	01	01	H2663_002_0	6	2	Non-Preferred Generic	1	4	000100	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	12.00																			4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	002	0	1	01	01	H2663_002_0	6	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	002	0	1	01	01	H2663_002_0	6	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					46.74	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	002	0	1	01	01	H2663_002_0	6	3	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	135.00																			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	6	3	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	135.00																			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	6	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					36.07	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	6	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	6	2	Non-Preferred Generic	1	4	000100	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	18.00																			6.00			.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	6	1	Preferred Generic	1	4	001000	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												
H2663	006	0	1	02	01	H2663_006_0	5	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	5	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					30.12	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	5	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	5	1	Preferred Generic	1	4	001000	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												
H2663	006	0	1	02	01	H2663_006_0	5	2	Non-Preferred Generic	1	4	000100	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	12.00																			4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	4	1	Preferred Generic	3	4	001000	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										1		
H2663	015	0	1	02	01	H2663_015_0	4	1	Preferred Generic	1	4	001000	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												
H2663	015	0	1	02	01	H2663_015_0	4	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					51.37	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	4	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	4	2	Non-Preferred Generic	1	4	000100	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	21.00																			7.00			.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	4	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	4	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	4	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					44.38	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	4	1	Preferred Generic	1	4	001000	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												
H2663	016	0	1	01	01	H2663_016_0	4	2	Non-Preferred Generic	1	4	000100	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	21.00																			7.00			.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	4	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	4	1	Preferred Generic	1	4	001000	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												
H2663	017	0	1	01	01	H2663_017_0	4	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					44.92	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	4	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	4	2	Non-Preferred Generic	1	4	000100	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	21.00																			7.00			.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	4	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	018	0	1	01	01	H2663_018_0	4	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	018	0	1	01	01	H2663_018_0	4	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					44.26	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	018	0	1	01	01	H2663_018_0	4	1	Preferred Generic	1	4	001000	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												
H2663	018	0	1	01	01	H2663_018_0	4	2	Non-Preferred Generic	1	4	000100	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	21.00																			7.00			.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	018	0	1	01	01	H2663_018_0	4	3	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	135.00																			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	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	0.00					.00	0.00	0.00	0.00					.00	0.00	0.00	0.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_001_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													45.26	50	50	50					42.17	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_001_0	5	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	0.00					.20	6.00	12.00	0.00					.20	6.00	12.00	0.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_001_0	5	3	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	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												
H2667	017	0	1	02	01	H2667_017_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	30.00					.20	6.00	12.00	18.00					.20	6.00	12.00	18.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	017	0	1	02	01	H2667_017_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					.00	0.00	0.00	0.00					.00	0.00	0.00	0.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	017	0	1	02	01	H2667_017_0	7	3	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	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												
H2667	017	0	1	02	01	H2667_017_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													37.99	50	50	50					35.91	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	017	0	1	02	01	H2667_017_0	7	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	001	0	1	01	01	H2672_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	25.00					.20	6.00	12.00	15.00					.20	6.00	12.00	15.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	001	0	1	01	01	H2672_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.66	20.00	40.00	50.00					.50	15.00	30.00	37.50					.50	15.00	30.00	37.50																			20.00			.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	001	0	1	01	01	H2672_001_0	5	3	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	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												
H2672	001	0	1	01	01	H2672_001_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													49.19	50	50	50					45.51	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	001	0	1	01	01	H2672_001_0	5	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.66	20.00	40.00	60.00					.50	15.00	30.00	45.00					.50	15.00	30.00	45.00																			20.00			.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	30.00					.20	6.00	12.00	18.00					.20	6.00	12.00	18.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_0	4	3	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	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												
H2672	008	0	1	01	01	H2672_008_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													56.95	50	50	50					48.27	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	009	0	1	01	01	H2672_009_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	0.00					.20	6.00	12.00	0.00					.20	6.00	12.00	0.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	009	0	1	01	01	H2672_009_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.66	20.00	40.00	60.00					.50	15.00	30.00	45.00					.50	15.00	30.00	45.00																			20.00			.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	009	0	1	01	01	H2672_009_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													51.12	50	50	50					53.63	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	009	0	1	01	01	H2672_009_0	5	3	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	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												
H2672	009	0	1	01	01	H2672_009_0	5	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	010	0	1	01	01	H2672_010_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.50	15.00	30.00	45.00					.33	10.00	20.00	30.00					.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	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.30	9.00	18.00	0.00					.20	6.00	12.00	0.00					.20	6.00	12.00	0.00																			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	4	3	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	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												
H2672	010	0	1	01	01	H2672_010_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	010	0	1	01	01	H2672_010_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													46.66	50	50	50					42.58	50	50	50					50	50	50																		50			50	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	10	111		1				30	60	90	1	30	60	90					10	31									.50	15.00	30.00	45.00					.33	10.00	20.00	30.00					.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	012	0	1	01	01	H2672_012_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	0.00					.16	5.00	10.00	0.00					.16	5.00	10.00	0.00																			10.00			.32	10.00		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	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		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	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													44.36	50	50	50					42.14	50	50	50					50	50	50																		50			50	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	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	018	0	1	01	01	H2672_018_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.23	7.00	14.00	17.50					.10	3.00	6.00	7.50					.10	3.00	6.00	7.50																			7.00			.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	018	0	1	01	01	H2672_018_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	018	0	1	01	01	H2672_018_0	5	3	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	112.50					1.50	45.00	90.00	112.50					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												
H2672	018	0	1	01	01	H2672_018_0	5	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2672	018	0	1	01	01	H2672_018_0	5	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	018	0	1	01	01	H2672_018_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													38.00	50	50	50					36.08	50	50	50					50	50	50																		50			50	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		21.00																		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	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		135.00																		45.00				1.45	45.00		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	3.16	95.00	190.00	285.00																					3.16	95.00		285.00																		95.00				3.06	95.00		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		33.00																		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	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					636.21	33	33	33																					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	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	4.00	8.00	8.00																					0.00	4.00	8.00	8.00																		4.00				0.00	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2701	003	0	1	04	01	H2701_003_0	6	6	Vaccines	1	4	101101	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, Vaccines												
H2701	003	0	1	04	01	H2701_003_0	6	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, Vaccines												
H2701	003	0	1	04	01	H2701_003_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	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, Vaccines												
H2701	003	0	1	04	01	H2701_003_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	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, Vaccines												
H2701	003	0	1	04	01	H2701_003_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, Vaccines												
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	4.00	8.00	8.00																					0.00	4.00	8.00	8.00																		4.00				0.00	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2701	006	0	1	04	01	H2701_006_0	5	6	Vaccines	1	4	101101	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, Vaccines												
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	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, Vaccines												
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, Vaccines												
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, Vaccines												
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, Vaccines												
H2751	002	0	1	48	05	H2751_002_0	6	5	Non-Medicare RX/OTC Drugs	1	4	010010			110		01	110		1	30		90				1	30		90				30		31																																																					Preferred Generic Drugs, Non-Preferred Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare RX/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2751	002	0	1	48	05	H2751_002_0	6	4	Non-Preferred Brand Drugs	1	4	110000			110		01	110		1	30		90				1	30		90				30		31																																																					Preferred Generic Drugs, Non-Preferred Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare RX/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2751	002	0	1	48	05	H2751_002_0	6	3	Preferred Brand Drugs	1	4	010001			110		01	110		1	30		90				1	30		90				30		31																																																					Preferred Generic Drugs, Non-Preferred Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare RX/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2751	002	0	1	48	05	H2751_002_0	6	1	Preferred Generic Drugs	1	4	001000			110		01	110		1	30		90				1	30		90				30		31																																																					Preferred Generic Drugs, Non-Preferred Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare RX/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2751	002	0	1	48	05	H2751_002_0	6	2	Non-Preferred Generic Drugs	1	4	000100			110		01	110		1	30		90				1	30		90				30		31																																																					Preferred Generic Drugs, Non-Preferred Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare RX/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2758	002	0	1	01	01	H2758_002_0	7	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	7	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												
H2758	002	0	1	01	01	H2758_002_0	7	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	7	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	7	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	7	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		
H2773	003	0	1	01	01	H2773_003_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																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	8	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	8	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	8	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	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												
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	2.42	75.00		225.00																					2.42	75.00		225.00																		75.00				2.42	75.00		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	.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	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	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	015	0	1	01	01	H2773_015_0	9	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	015	0	1	01	01	H2773_015_0	9	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	9	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	.65	20.00		60.00																					.65	20.00		60.00																		20.00				.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	015	0	1	01	01	H2773_015_0	9	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	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												
H2773	015	0	1	01	01	H2773_015_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		
H2773	017	0	1	01	01	H2773_017_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												
H2773	017	0	1	01	01	H2773_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																					.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	8	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	.81	25.00		75.00																					.81	25.00		75.00																		25.00				.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	8	4	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	31		90				1	31		90				31		31	2.42	75.00		225.00																					2.42	75.00		225.00																		75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	8	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	8	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	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	018	0	1	01	01	H2773_018_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	018	0	1	01	01	H2773_018_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	018	0	1	01	01	H2773_018_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	018	0	1	01	01	H2773_018_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	018	0	1	01	01	H2773_018_0	7	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	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																					.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	8	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	019	0	1	01	01	H2773_019_0	8	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	8	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	8	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												
H2775	082	0	1	04	01	H2775_082_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		200.00				2.67	80.00		80.00				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	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		100.00				1.33	40.00		40.00				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	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		17.50				.23	7.00		7.00				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	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		5.00				.07	2.00		2.00				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	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												
H2775	083	0	1	04	01	H2775_083_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		200.00				2.67	80.00		80.00				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	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		100.00				1.33	40.00		40.00				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	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		17.50				.23	7.00		7.00				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	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		5.00				.07	2.00		2.00				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	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												
H2775	088	0	1	04	01	H2775_088_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		12.50				.17	5.00		5.00				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_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		30.00				.40	12.00		12.00				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	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		112.50				1.50	45.00		45.00				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	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		237.50				3.17	95.00		95.00				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	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												
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		237.50				3.17	95.00		95.00				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	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		112.50				1.50	45.00		45.00				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		30.00				.40	12.00		12.00				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		12.50				.17	5.00		5.00				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	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												
H2802	001	0	1	01	01	H2802_001_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	2	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																															24.00							16.00				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	2	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							125.00				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	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					661.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	0.12	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, Specialty Tier												
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	0.22	10.00	20.00	30.00																					0.22	10.00	20.00	30.00																		10.00				0.22	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	1.09	37.00	74.00	111.00																					1.09	37.00	74.00	111.00																		37.00				1.09	37.00		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	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.32	87.00	174.00	261.00																					2.32	87.00	174.00	261.00																		87.00				2.32	87.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2810	001	0	1	04	01	H2810_001_0	6	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					624.60	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_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		17.50				.23	7.00		7.00				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	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												
H2816	013	0	1	09	04	H2816_013_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		200.00				2.67	80.00		80.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_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		100.00				1.33	40.00		40.00				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	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		5.00				.07	2.00		2.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_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		112.50				1.50	45.00		45.00				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	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		30.00				.40	12.00		12.00				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	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		12.50				.17	5.00		5.00				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_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												
H2816	019	0	1	09	04	H2816_019_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		237.50				3.17	95.00		95.00				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	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		237.50				3.17	95.00		95.00				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	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		12.50				.17	5.00		5.00				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	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		30.00				.40	12.00		12.00				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	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		112.50				1.50	45.00		45.00				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	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												
H2816	027	0	1	09	04	H2816_027_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		200.00				2.67	80.00		80.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	027	0	1	09	04	H2816_027_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		100.00				1.33	40.00		40.00				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	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		17.50				.23	7.00		7.00				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	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												
H2816	027	0	1	09	04	H2816_027_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		5.00				.07	2.00		2.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2836	004	0	1	04	01	H2836_004_0	14	6	Select Care Drugs	1	3	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												
H2836	004	0	1	04	01	H2836_004_0	14	5	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, Specialty Tier, Select Care Drugs												
H2836	004	0	1	04	01	H2836_004_0	14	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2836	004	0	1	04	01	H2836_004_0	14	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2836	004	0	1	04	01	H2836_004_0	14	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.80	24.00	48.00	72.00					.63	19.00	38.00	57.00					.63	19.00	38.00	38.00																		24.00				.70	24.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2836	004	0	1	04	01	H2836_004_0	14	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2905	001	0	1	04	01	H2905_001_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2905	001	0	1	04	01	H2905_001_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2905	001	0	1	04	01	H2905_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																															135.00							125.00				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	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2905	001	0	1	04	01	H2905_001_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					801.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	003	0	1	04	01	H2906_003_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	003	0	1	04	01	H2906_003_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	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	003	0	1	04	01	H2906_003_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.27	8.00		20.00																								16.00																		8.00				.26	8.00		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	6	3	Preferred Brand	3	4	000001	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										1		
H2906	003	0	1	04	01	H2906_003_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	003	0	1	04	01	H2906_003_0	6	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				2.26	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	6	6	Select Diabetic Drugs	3	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	.66	20.00		50.00																								40.00																		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	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.27	8.00		20.00																								16.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	003	0	1	04	01	H2906_003_0	6	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	6	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	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.67	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	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	005	0	1	04	01	H2906_005_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.27	8.00		20.00																								16.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	005	0	1	04	01	H2906_005_0	6	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	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	005	0	1	04	01	H2906_005_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.27	8.00		20.00																								16.00																		8.00				.26	8.00		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	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	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	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	006	0	1	04	01	H2906_006_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				.13	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	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.40	12.00		30.00																								24.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	006	0	1	04	01	H2906_006_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.40	12.00		30.00																								24.00																		12.00				.39	12.00		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	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	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										1		
H2906	006	0	1	04	01	H2906_006_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	006	0	1	04	01	H2906_006_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	006	0	1	04	01	H2906_006_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.67	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	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	1	Preferred Generic	1	4	001000	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	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	0.20	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	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	3.17	95.00		237.50																								190.00																		95.00				3.06	95.00		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	0.47	14.00		35.00																								28.00																		14.00				.45	14.00		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	.47	14.00		35.00																								28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2931	002	0	1	01	01	H2931_002_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_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																															135.00							125.00				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	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																															285.00							275.00				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	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					750.00	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	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2931	002	0	1	01	01	H2931_002_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2931	004	0	1	01	01	H2931_004_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_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							125.00				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	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							275.00				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	4	5	Specialty Tier	1	3	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												
H2944	004	0	1	09	04	H2944_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		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												
H2944	004	0	1	09	04	H2944_004_0	4	5	Specialty Tier	1	3	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												
H2944	004	0	1	09	04	H2944_004_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		12.00				0.13	4.00		0.00				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	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		30.00				0.33	10.00		0.00				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	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		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												
H2944	013	0	1	09	04	H2944_013_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	013	0	1	09	04	H2944_013_0	3	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		42.00				0.46	14.00		0.00				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	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		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										2	3	
H2944	013	0	1	09	04	H2944_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		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										2	3	
H2944	013	0	1	09	04	H2944_013_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H2944	013	0	1	09	04	H2944_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		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												
H2944	013	0	1	09	04	H2944_013_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	3	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		42.00				0.46	14.00		0.00				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	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	041	0	1	09	04	H2944_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	041	0	1	09	04	H2944_041_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	041	0	1	09	04	H2944_041_0	4	5	Specialty Tier	1	4	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												
H2944	041	0	1	09	04	H2944_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		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												
H2944	041	0	1	09	04	H2944_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		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												
H2944	041	0	1	09	04	H2944_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	041	0	1	09	04	H2944_041_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	041	0	1	09	04	H2944_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		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										2	3	
H2944	041	0	1	09	04	H2944_041_0	4	5	Specialty Tier	3	4	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										2	3	
H2944	041	0	1	09	04	H2944_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		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										2	3	
H2944	078	0	1	09	04	H2944_078_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		18.00				0.20	6.00		0.00				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	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		54.00				0.60	18.00		0.00				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	3	5	Specialty Tier	3	4	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										2	3	
H2944	078	0	1	09	04	H2944_078_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		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										2	3	
H2944	078	0	1	09	04	H2944_078_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		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										2	3	
H2944	078	0	1	09	04	H2944_078_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	078	0	1	09	04	H2944_078_0	3	5	Specialty Tier	1	4	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												
H2944	078	0	1	09	04	H2944_078_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		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												
H2944	078	0	1	09	04	H2944_078_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		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												
H2944	085	0	1	09	04	H2944_085_0	3	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.63	19.00		57.00																												0.63	19.00		57.00				0.63	19.00		0.00				19.00				0.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	085	0	1	09	04	H2944_085_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		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												
H2944	085	0	1	09	04	H2944_085_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		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												
H2944	085	0	1	09	04	H2944_085_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	085	0	1	09	04	H2944_085_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		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						25																														25							25					25				25	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	0.46	14.00		42.00																												0.46	14.00		42.00				0.46	14.00		0.00				14.00				0.45	14.00		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		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												
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		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												
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		18.00				0.20	6.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	124	0	1	09	04	H2944_124_0	3	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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		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		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										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		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										2	3	
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						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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		18.00				0.20	6.00		0.00				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	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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		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		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												
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		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												
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						25																														25							25					25				25	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	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		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										2	3	
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		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										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						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	0.06	2.00		6.00																												0.06	2.00		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												
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	0.33	10.00		30.00																												0.33	10.00		30.00				0.33	10.00		0.00				10.00				0.32	10.00		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		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												
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		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												
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						25																														25							25					25				25	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	0.06	2.00		6.00																												0.06	2.00		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										2	3	
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	0.33	10.00		30.00																												0.33	10.00		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	133	0	1	09	04	H2944_133_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		18.00				0.20	6.00		0.00				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	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		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										2	3	
H2944	133	0	1	09	04	H2944_133_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		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										2	3	
H2944	133	0	1	09	04	H2944_133_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		54.00				0.60	18.00		0.00				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	4	5	Specialty Tier	3	4	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										2	3	
H2944	133	0	1	09	04	H2944_133_0	4	5	Specialty Tier	1	4	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												
H2944	133	0	1	09	04	H2944_133_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		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												
H2944	133	0	1	09	04	H2944_133_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		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												
H2944	133	0	1	09	04	H2944_133_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	012	0	1	01	01	H2949_012_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		
H2949	012	0	1	01	01	H2949_012_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2949	012	0	1	01	01	H2949_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		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										2	3	
H2949	012	0	1	01	01	H2949_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		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										2	3	
H2949	012	0	1	01	01	H2949_012_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H2949	012	0	1	01	01	H2949_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		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												
H2949	012	0	1	01	01	H2949_012_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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												
H2949	012	0	1	01	01	H2949_012_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H2949	013	0	1	01	01	H2949_013_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		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										2	3	
H2949	013	0	1	01	01	H2949_013_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		15.00				0.16	5.00		0.00				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	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				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	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		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												
H2949	013	0	1	01	01	H2949_013_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		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												
H2949	013	0	1	01	01	H2949_013_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		15.00				0.16	5.00		0.00				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	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		15.00				0.16	5.00		0.00				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	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		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										2	3	
H2949	014	0	1	01	01	H2949_014_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		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										2	3	
H2949	014	0	1	01	01	H2949_014_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H2949	014	0	1	01	01	H2949_014_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		15.00				0.16	5.00		0.00				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	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		15.00				0.16	5.00		0.00				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	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		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												
H2949	014	0	1	01	01	H2949_014_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		15.00				0.16	5.00		0.00				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	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		15.00				0.16	5.00		0.00				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	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_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		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												
H2949	018	0	1	01	01	H2949_018_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	018	0	1	01	01	H2949_018_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		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												
H2949	018	0	1	01	01	H2949_018_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		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												
H2949	018	0	1	01	01	H2949_018_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	018	0	1	01	01	H2949_018_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	004	0	1	01	01	H2960_004_0	7	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	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.40	12.00		30.00																								24.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	004	0	1	01	01	H2960_004_0	7	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	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.40	12.00		30.00																								24.00																		12.00				.39	12.00		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	7	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	7	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	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	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	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.17	95.00		237.50																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	010	0	1	01	01	H2960_010_0	6	6	Select Diabetic Drugs	3	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	.66	20.00		50.00																								40.00																		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	6	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	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.27	8.00		20.00																								16.00																		8.00				.26	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	6	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	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.67	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	010	0	1	01	01	H2960_010_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												
H2960	010	0	1	01	01	H2960_010_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												
H2960	010	0	1	01	01	H2960_010_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	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	010	0	1	01	01	H2960_010_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.27	8.00		20.00																								16.00																		8.00				.26	8.00		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	6	3	Preferred Brand	3	4	000001	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										1		
H2960	012	0	1	01	01	H2960_012_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.17	95.00		237.50																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	012	0	1	01	01	H2960_012_0	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												
H2960	012	0	1	01	01	H2960_012_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												
H2960	012	0	1	01	01	H2960_012_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.47	14.00		35.00																								28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	012	0	1	01	01	H2960_012_0	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												
H2960	012	0	1	01	01	H2960_012_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												
H2960	012	0	1	01	01	H2960_012_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	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	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.47	14.00		35.00																								28.00																		14.00				.45	14.00		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	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	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	6	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	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												
H2960	018	0	1	01	01	H2960_018_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		
H2960	018	0	1	01	01	H2960_018_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	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	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												
H2960	018	0	1	01	01	H2960_018_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												
H2960	018	0	1	01	01	H2960_018_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.17	95.00		237.50																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2962	001	0	1	01	01	H2962_001_0	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, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	001	0	1	01	01	H2962_001_0	12	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					148.04	33		33																							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	12	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.67	50.00		150.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	12	2	Preferred Brand	1	4	000101	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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	12	2	Preferred Brand	3	4	000101	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, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2962	002	0	1	01	01	H2962_002_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, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	002	0	1	01	01	H2962_002_0	11	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					226.48	33		33																							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	11	3	Non-Preferred Brand	1	4	100000	3	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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	11	2	Preferred Brand	1	4	000101	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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_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																								0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	11	2	Preferred Brand	3	4	000101	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, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2962	003	0	1	01	01	H2962_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																								0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_0	11	2	Preferred Brand	1	4	000101	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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_0	11	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.67	50.00		150.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_0	11	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					203.91	33		33																							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_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, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	003	0	1	01	01	H2962_003_0	11	2	Preferred Brand	3	4	000101	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, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2962	004	0	1	01	01	H2962_004_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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	004	0	1	01	01	H2962_004_0	11	2	Preferred Brand	1	4	000101	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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	004	0	1	01	01	H2962_004_0	11	3	Non-Preferred Brand	1	4	100000	3	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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	004	0	1	01	01	H2962_004_0	11	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					208.66	33		33																							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	004	0	1	01	01	H2962_004_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, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	004	0	1	01	01	H2962_004_0	11	2	Preferred Brand	3	4	000101	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, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2968	001	0	1	04	01	H2968_001_0	5	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												
H2968	001	0	1	04	01	H2968_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.17	5.00	10.00	12.50																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.17	5.00	10.00	12.50																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2968	001	0	1	04	01	H2968_001_0	5	1	Preferred Generic	3	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										1		
H2968	001	0	1	04	01	H2968_001_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31						30	30	30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	2.83	85.00	170.00	212.50																								170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_0	5	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	112.50																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2986	001	0	1	01	01	H2986_001_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	34		90				1	34		90				34		34	.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, Select Diabetic Drugs												
H2986	001	0	1	01	01	H2986_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	34		90				1	34		90				34		34	.44	15.00		45.00																					.44	15.00		30.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	001	0	1	01	01	H2986_001_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	34		90				1	34		90				34		34	.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, Select Diabetic Drugs										1		
H2986	001	0	1	01	01	H2986_001_0	7	6	Select Diabetic Drugs	1	4	001001	1	2	110		01	110		1	34		90				1	34		90				34		34	0.06	2.00		6.00																					0.06	2.00		4.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	001	0	1	01	01	H2986_001_0	7	5	Specialty Tier	1	4	001001	1	1	110		01	110		1	34		90				1	34		90				34		34					200.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	001	0	1	01	01	H2986_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	34		90				1	34		90				34		34	2.79	95.00		285.00																					2.79	95.00		190.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	001	0	1	01	01	H2986_001_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		135.00																					1.32	45.00		90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	001	0	1	01	01	H2986_001_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	34		90				1	34		90				34		34	.44	15.00		45.00																					.44	15.00		30.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H3018	001	0	1	48	05	H3018_001_0	4	3	Non-Medicare Rx Drugs	1	4	010010			110		01			1	30		90				1							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			
H3018	001	0	1	48	05	H3018_001_0	4	2	Brand Drugs	1	4	000010			110		01			1	30		90				1							30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00			0.00	0.00			
H3018	001	0	1	48	05	H3018_001_0	4	1	Generic Drugs	1	4	010000			110		01			1	30		90				1							30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00			0.00	0.00			
H3018	001	0	1	48	05	H3018_001_0	4	4	Non-Medicare OTC Drugs	1	4	010010			110		01			1	30		90				1							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			
H3054	001	0	1	01	01	H3054_001_0	8	4	Specialty Tier	1	2	100000	1	1	111		01	100		1	30	60	90				1			90				30		31					100.00	25	25	25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	001	0	1	01	01	H3054_001_0	8	3	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.06	95.00	190.00	285.00																								190.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	001	0	1	01	01	H3054_001_0	8	1	Generic	1	2	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	.21	6.50	13.00	19.50																								13.00																		6.50				.21	6.50		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	001	0	1	01	01	H3054_001_0	8	2	Preferred Brand	1	2	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.45	45.00	90.00	135.00																								90.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3067	001	0	1	48	05	H3067_001_0	5	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	0.00	2.65	0.00	2.65			0.00	2.65			
H3067	001	0	1	48	05	H3067_001_0	5	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	0.00	6.60	0.00	6.60			0.00	6.60			
H3067	001	0	1	48	05	H3067_001_0	5	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	8	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.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												
H3071	002	0	1	01	01	H3071_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	.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												
H3071	002	0	1	01	01	H3071_002_0	8	3	Preferred Brand	1	4	010001	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												
H3071	002	0	1	01	01	H3071_002_0	8	4	Non-Preferred Brand	1	4	110000	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												
H3071	002	0	1	01	01	H3071_002_0	8	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					325.00	33	33	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	004	0	1	01	01	H3107_004_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					708.00	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	2	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							275.00				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	2	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							125.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	012	0	1	01	01	H3107_012_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				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	2	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							125.00				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	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					745.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	013	0	1	01	01	H3107_013_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	013	0	1	01	01	H3107_013_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	013	0	1	01	01	H3107_013_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	013	0	1	01	01	H3107_013_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	013	0	1	01	01	H3107_013_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					708.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	014	0	1	01	01	H3107_014_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	014	0	1	01	01	H3107_014_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	014	0	1	01	01	H3107_014_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	014	0	1	01	01	H3107_014_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	014	0	1	01	01	H3107_014_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					708.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3113	008	0	1	01	01	H3113_008_0	3	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							8.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3113	008	0	1	01	01	H3113_008_0	3	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												
H3113	008	0	1	01	01	H3113_008_0	3	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.23	7.00		21.00																															21.00							14.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3113	008	0	1	01	01	H3113_008_0	3	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3113	008	0	1	01	01	H3113_008_0	3	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3129	001	0	1	48	05	H3129_001_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		01			1	30													30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H3129	001	0	1	48	05	H3129_001_0	4	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				1			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			
H3129	001	0	1	48	05	H3129_001_0	4	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				1			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			
H3132	001	0	1	01	01	H3132_001_0	8	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												
H3132	001	0	1	01	01	H3132_001_0	8	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	8	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												
H3152	022	0	1	01	01	H3152_022_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	8.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	8.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	12.00					0.06	2.00	4.00	4.00												0.20	6.00	12.00	12.00				0.06	2.00	4.00	4.00					6.00			0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	5	3	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	135.00												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												
H3152	022	0	1	01	01	H3152_022_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													52.07	50	50	50					49.17	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	28							1.00	28														28							28						28			28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	046	0	1	01	01	H3152_046_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	12.00					0.00	0.00	0.00	0.00												0.20	6.00	12.00	12.00				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												
H3152	046	0	1	01	01	H3152_046_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.46	14.00	28.00	28.00					0.26	8.00	16.00	16.00												0.46	14.00	28.00	28.00				0.26	8.00	16.00	16.00					14.00			0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	046	0	1	01	01	H3152_046_0	5	3	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	135.00												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												
H3152	046	0	1	01	01	H3152_046_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													49.52	50	50	50					47.08	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	046	0	1	01	01	H3152_046_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	077	0	1	01	01	H3152_077_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	8.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	8.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	077	0	1	01	01	H3152_077_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.43	13.00	26.00	26.00					0.30	9.00	18.00	18.00												0.43	13.00	26.00	26.00				0.30	9.00	18.00	18.00					13.00			0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	077	0	1	01	01	H3152_077_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	077	0	1	01	01	H3152_077_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													49.21	50	50	50					46.96	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	077	0	1	01	01	H3152_077_0	4	3	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	135.00												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												
H3152	080	0	1	01	01	H3152_080_0	5	3	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	135.00												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												
H3152	080	0	1	01	01	H3152_080_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.40	12.00	24.00	24.00					0.20	6.00	12.00	12.00												0.40	12.00	24.00	24.00				0.20	6.00	12.00	12.00					12.00			0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H3152	080	0	1	01	01	H3152_080_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	12.00					0.00	0.00	0.00	0.00												0.20	6.00	12.00	12.00				0.00	0.00	0.00	0.00					6.00			0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H3152	080	0	1	01	01	H3152_080_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													51.43	50	50	50					49.31	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H3154	004	0	1	01	01	H3154_004_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	004	0	1	01	01	H3154_004_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	004	0	1	01	01	H3154_004_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	004	0	1	01	01	H3154_004_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												
H3154	004	0	1	01	01	H3154_004_0	8	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.23	7.00	14.00	21.00																					0.11	3.50	7.00	10.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_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	022	0	1	01	01	H3154_022_0	10	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.23	7.00	14.00	21.00																					0.11	3.50	7.00	10.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_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	022	0	1	01	01	H3154_022_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	022	0	1	01	01	H3154_022_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	024	0	1	01	01	H3154_024_0	7	4	Non-Preferred Brand	1	2	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	240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	024	0	1	01	01	H3154_024_0	7	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												
H3154	024	0	1	01	01	H3154_024_0	7	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.20	6.00	12.00	18.00																					0.10	3.00	6.00	9.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	024	0	1	01	01	H3154_024_0	7	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	024	0	1	01	01	H3154_024_0	7	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	026	0	1	01	01	H3154_026_0	7	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	026	0	1	01	01	H3154_026_0	7	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	026	0	1	01	01	H3154_026_0	7	4	Non-Preferred Brand	1	2	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	240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	026	0	1	01	01	H3154_026_0	7	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												
H3154	026	0	1	01	01	H3154_026_0	7	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.20	6.00	12.00	18.00																					0.10	3.00	6.00	9.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	027	0	1	01	01	H3154_027_0	8	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.20	6.00	12.00	18.00																					0.10	3.00	6.00	9.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	027	0	1	01	01	H3154_027_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	027	0	1	01	01	H3154_027_0	8	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												
H3154	027	0	1	01	01	H3154_027_0	8	4	Non-Preferred Brand	1	2	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.66	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												
H3154	027	0	1	01	01	H3154_027_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	028	0	1	01	01	H3154_028_0	7	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	028	0	1	01	01	H3154_028_0	7	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.20	6.00	12.00	18.00																					0.10	3.00	6.00	9.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	028	0	1	01	01	H3154_028_0	7	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												
H3154	028	0	1	01	01	H3154_028_0	7	4	Non-Preferred Brand	1	2	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	240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	028	0	1	01	01	H3154_028_0	7	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												
H3156	030	0	1	01	01	H3156_030_0	3	2	Non-Preferred Generic	1	3	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	18.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	030	0	1	01	01	H3156_030_0	3	1	Preferred Generic	1	3	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	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	030	0	1	01	01	H3156_030_0	3	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	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	3	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					689.64	25	25	25																					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	3	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	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	3	1	Preferred Generic	1	3	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	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	034	0	1	01	01	H3156_034_0	3	2	Non-Preferred Generic	1	3	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	18.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	034	0	1	01	01	H3156_034_0	3	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	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	3	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	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	3	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					696.01	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	036	0	1	01	01	H3156_036_0	3	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	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	036	0	1	01	01	H3156_036_0	3	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	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	036	0	1	01	01	H3156_036_0	3	1	Preferred Generic	1	3	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	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	036	0	1	01	01	H3156_036_0	3	2	Non-Preferred Generic	1	3	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	18.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	036	0	1	01	01	H3156_036_0	3	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					696.01	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	8	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	8	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	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																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	8	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	8	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	007	0	1	01	01	H3204_007_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																								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	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												
H3204	007	0	1	01	01	H3204_007_0	7	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	7	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	7	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	7	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	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												
H3206	001	0	1	04	01	H3206_001_0	6	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	6	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	6	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	6	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												
H3206	001	0	1	04	01	H3206_001_0	6	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	6	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	6	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	6	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	002	0	1	04	01	H3206_002_0	6	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												
H3206	002	0	1	04	01	H3206_002_0	6	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	6	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	6	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												
H3233	001	0	1	01	01	H3233_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		
H3233	001	0	1	01	01	H3233_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3233	001	0	1	01	01	H3233_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												
H3233	001	0	1	01	01	H3233_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												
H3233	001	0	1	01	01	H3233_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	0.30	9.00	18.00	27.00																					0.30	9.00	18.00	27.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3233	001	0	1	01	01	H3233_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												
H3237	001	0	1	48	05	H3237_001_0	2	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	0.00	2.65	0.00	2.65	0.00	2.65	0.00	2.65			
H3237	001	0	1	48	05	H3237_001_0	2	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	2	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	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
H3237	002	0	1	48	05	H3237_002_0	2	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	2	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	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
H3237	002	0	1	48	05	H3237_002_0	2	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	0.00	2.65	0.00	2.65	0.00	2.65	0.00	2.65			
H3240	013	0	1	01	01	H3240_013_0	10	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	10	5	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, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	10	6	Select Care Drugs	1	3	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												
H3240	013	0	1	01	01	H3240_013_0	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.16	5.00	10.00	15.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	10	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		40.00				1.17	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	10	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.26	8.00	16.00	24.00					.26	8.00	16.00	24.00					.26	8.00	16.00	16.00																		8.00				.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3251	002	0	1	01	01	H3251_002_0	9	1	Preferred Generic	1	4	001000	1	2	111		10	100		1	30	60	90				1			90					29	31	0.13	4.00	8.00	12.00																								12.00																			4.00			0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		10	100		1	30	60	90				1			90					29	31	.33	10.00	20.00	30.00																								30.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	9	3	Preferred Brand	1	4	000001	1	2	111		10	100		1	30	60	90				1			90					29	31	1.50	45.00	90.00	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	9	4	Non-Preferred Brand	1	4	100000	1	2	111		10	100		1	30	60	90				1			90					29	31	3.17	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												
H3251	002	0	1	01	01	H3251_002_0	9	5	Specialty Tier	1	4	000010	1	1	010		10			1	30														29	31						33																																											33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	9	1	Preferred Generic	3	4	001000	1	2	111		10	100		1	30	60	90				1			90					29	31	.13	4.00	8.00	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	9	2	Non-Preferred Generic	3	4	000100	1	2	111		10	100		1	30	60	90				1			90					29	31	.33	10.00	20.00	30.00																								30.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	021	0	1	02	01	H3251_021_0	10	1	Preferred Generic	1	4	001000	1	2	111		10	100		1	30	60	90				1			90					29	31	0.13	4.00	8.00	12.00																								12.00																			4.00			0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	10	2	Non-Preferred Generic	1	4	000100	1	2	111		10	100		1	30	60	90				1			90					29	31	.33	10.00	20.00	30.00																								30.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	10	3	Preferred Brand	1	4	000001	1	2	111		10	100		1	30	60	90				1			90					29	31	1.50	45.00	90.00	135.00																								135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		10	100		1	30	60	90				1			90					29	31	3.17	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												
H3251	021	0	1	02	01	H3251_021_0	10	5	Specialty Tier	1	4	000010	1	1	010		10			1	30														29	31						33																																											33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	10	1	Preferred Generic	3	4	001000	1	2	111		10	100		1	30	60	90				1			90					29	31	.13	4.00	8.00	12.00																								12.00																			4.00			.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	021	0	1	02	01	H3251_021_0	10	2	Non-Preferred Generic	3	4	000100	1	2	111		10	100		1	30	60	90				1			90					29	31	.33	10.00	20.00	30.00																								30.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3305	015	0	1	02	01	H3305_015_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3305	015	0	1	02	01	H3305_015_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												
H3305	015	0	1	02	01	H3305_015_0	10	3	Preferred Brand	1	4	000101	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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3305	015	0	1	02	01	H3305_015_0	10	4	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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3305	015	0	1	02	01	H3305_015_0	10	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				2	30		90				30		31					50.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3305	015	0	1	02	01	H3305_015_0	10	6	Vaccines	1	4	010010	1	2	010		01	010		1	30							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												
H3305	015	0	1	02	01	H3305_015_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3305	015	0	1	02	01	H3305_015_0	10	6	Vaccines	3	4	010010	1	2	010		01	010		1	30							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		
H3307	002	0	1	01	01	H3307_002_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				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	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					686.00	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	2	5	Specialty Tier	1	3	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												
H3307	012	0	1	01	01	H3307_012_0	2	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							275.00				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	2	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							125.00				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	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																															30.00							20.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_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																															9.00							6.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	2	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																															18.00							12.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.46	44.00		132.00																															132.00							122.00				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	2	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																															285.00							275.00				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	2	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												
H3307	023	0	1	01	01	H3307_023_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_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																															30.00							20.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	2	5	Specialty Tier	1	3	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												
H3312	002	0	1	01	01	H3312_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.46	14.00	28.00	28.00					0.26	8.00	16.00	16.00												0.46	14.00	28.00	28.00				0.26	8.00	16.00	16.00					14.00			0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.30	9.00	18.00	18.00					0.10	3.00	6.00	6.00												0.30	9.00	18.00	18.00				0.10	3.00	6.00	6.00					9.00			0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	5	3	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	135.00												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												
H3312	002	0	1	01	01	H3312_002_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													53.58	50	50	50					49.22	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.30	9.00	18.00	18.00					0.10	3.00	6.00	6.00												0.30	9.00	18.00	18.00				0.10	3.00	6.00	6.00					9.00			0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.46	14.00	28.00	28.00					0.26	8.00	16.00	16.00												0.46	14.00	28.00	28.00				0.26	8.00	16.00	16.00					14.00			0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	5	3	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	135.00												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												
H3312	018	0	1	01	01	H3312_018_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													52.18	50	50	50					48.34	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.40	12.00	24.00	24.00					0.20	6.00	12.00	12.00												0.40	12.00	24.00	24.00				0.20	6.00	12.00	12.00					12.00			0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	12.00					0.00	0.00	0.00	0.00												0.20	6.00	12.00	12.00				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												
H3312	048	0	1	01	01	H3312_048_0	4	3	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	135.00												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												
H3312	048	0	1	01	01	H3312_048_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													44.87	50	50	50					40.93	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	060	0	1	01	01	H3312_060_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	12.00					0.00	0.00	0.00	0.00												0.20	6.00	12.00	12.00				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												
H3312	060	0	1	01	01	H3312_060_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.46	14.00	28.00	28.00					0.26	8.00	16.00	16.00												0.46	14.00	28.00	28.00				0.26	8.00	16.00	16.00					14.00			0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	060	0	1	01	01	H3312_060_0	5	3	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	135.00												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												
H3312	060	0	1	01	01	H3312_060_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													41.83	50	50	50					39.24	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	060	0	1	01	01	H3312_060_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	061	0	1	01	01	H3312_061_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	12.00					0.00	0.00	0.00	0.00												0.20	6.00	12.00	12.00				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												
H3312	061	0	1	01	01	H3312_061_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.46	14.00	28.00	28.00					0.26	8.00	16.00	16.00												0.46	14.00	28.00	28.00				0.26	8.00	16.00	16.00					14.00			0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	061	0	1	01	01	H3312_061_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													53.75	50	50	50					51.40	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	061	0	1	01	01	H3312_061_0	5	3	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	135.00												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												
H3312	061	0	1	01	01	H3312_061_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	001	0	1	01	01	H3327_001_0	7	1	Preferred Generic	1	4	001000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	001	0	1	01	01	H3327_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				2			90				30		31	0.33	10.00	20.00	30.00																								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	001	0	1	01	01	H3327_001_0	7	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				2			90				30		31					519.31	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	001	0	1	01	01	H3327_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	2.67	80.00	160.00	240.00																								200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	001	0	1	01	01	H3327_001_0	7	3	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																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	7	3	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																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	7	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				2			90				30		31					487.69	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	2.67	80.00	160.00	240.00																								200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				2			90				30		31	0.23	7.00	14.00	21.00																								17.50																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	7	1	Preferred Generic	1	4	001000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	038	0	1	02	01	H3327_038_0	8	3	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																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	038	0	1	02	01	H3327_038_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				2			90				30		31	0.33	10.00	20.00	30.00																								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	038	0	1	02	01	H3327_038_0	8	1	Preferred Generic	1	4	001000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	038	0	1	02	01	H3327_038_0	8	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				2			90				30		31					536.56	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	038	0	1	02	01	H3327_038_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	2.67	80.00	160.00	240.00																								200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	040	0	1	01	01	H3327_040_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	2.67	80.00	160.00	240.00																								200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	040	0	1	01	01	H3327_040_0	5	3	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																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	040	0	1	01	01	H3327_040_0	5	1	Preferred Generic	1	4	001000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	040	0	1	01	01	H3327_040_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				2			90				30		31					449.84	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	040	0	1	01	01	H3327_040_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				2			90				30		31	0.33	10.00	20.00	30.00																								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	041	0	1	01	01	H3327_041_0	7	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				2			90				30		31					499.71	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	041	0	1	01	01	H3327_041_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	2.67	80.00	160.00	240.00																								200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	041	0	1	01	01	H3327_041_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				2			90				30		31	0.23	7.00	14.00	21.00																								17.50																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	041	0	1	01	01	H3327_041_0	7	3	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																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	041	0	1	01	01	H3327_041_0	7	1	Preferred Generic	1	4	001000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	9	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	30		90				1			90				30		34	0.30	9.00		27.00																								18.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	9	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	9	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		34					432.00	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	9	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	002	0	1	01	01	H3328_002_0	9	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	003	0	1	02	01	H3328_003_0	12	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					539.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	12	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	12	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	12	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	12	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	016	0	1	01	01	H3328_016_0	9	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		34					472.00	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	9	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	9	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	9	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	30		90				1			90				30		34	0.40	12.00		36.00																								24.00																		12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	9	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	017	0	1	01	01	H3328_017_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		34	0.70	21.00		63.00																								42.00																		21.00				0.61	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	10	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	10	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	10	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	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		34					471.00	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	10	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	019	0	1	01	01	H3328_019_0	9	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	9	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	9	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	9	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					384.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	019	0	1	01	01	H3328_019_0	9	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												
H3330	021	1	1	01	01	H3330_021_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	021	1	1	01	01	H3330_021_1	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																					1.33	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	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																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_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																					.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	8	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					826.97	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	9	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	9	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																					1.33	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	9	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												
H3330	021	2	1	01	01	H3330_021_2	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												
H3330	021	2	1	01	01	H3330_021_2	9	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					826.97	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	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																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_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																					.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	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																					1.33	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_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	021	3	1	01	01	H3330_021_3	8	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					826.97	33	33	33																					33	33	33																	33				33	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	3	Preferred Brand	1	2	000001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					57.30	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	4	Non-Preferred Brand	1	2	100000	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					94.39	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	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					353.32	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	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	032	1	1	01	01	H3330_032_1	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.33	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												
H3330	032	1	1	01	01	H3330_032_1	7	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					701.52	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	1	1	01	01	H3330_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	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	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	1.33	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												
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	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		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					701.52	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_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	032	3	1	01	01	H3330_032_3	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																					1.33	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_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	032	3	1	01	01	H3330_032_3	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																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	7	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					701.52	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	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																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_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																					.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	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																					1.33	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_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	033	1	1	01	01	H3330_033_1	8	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					718.44	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	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																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	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																					.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	10	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	10	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																					1.33	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	10	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					718.44	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	10	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																					1.33	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	10	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	3	1	01	01	H3330_033_3	10	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					718.44	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	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																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	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																					.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	035	0	1	01	01	H3330_035_0	11	1	Preferred Generic	1	2	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	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	035	0	1	01	01	H3330_035_0	11	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	035	0	1	01	01	H3330_035_0	11	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					423.59	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	035	0	1	01	01	H3330_035_0	11	4	Non-Preferred Brand	1	2	100000	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					82.65	30	30	30																					30	30	30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	035	0	1	01	01	H3330_035_0	11	3	Preferred Brand	1	2	000001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					68.64	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	2.00		5.00																								5.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_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																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	8	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	8	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	7	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	7	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	2.00		5.00																								5.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	7	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	2.00		5.00																								5.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	7	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	7	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	2.00		5.00																								5.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	7	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	7	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	7	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	7	1	Preferred Generic	1	3	001000	1	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	7	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.66	20.00		50.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	7	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		10.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	7	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	7	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_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		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	7	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		10.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	7	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	052	0	1	04	01	H3335_052_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																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	052	0	1	04	01	H3335_052_0	6	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		10.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	052	0	1	04	01	H3335_052_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	2.00		5.00																								5.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	052	0	1	04	01	H3335_052_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	052	0	1	04	01	H3335_052_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		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	6	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												
H3337	001	0	1	01	01	H3337_001_0	6	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	31		90				1			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												
H3337	001	0	1	01	01	H3337_001_0	6	3	Preferred Brand	1	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	31		90				2			90				31		31	2.42	75.00		225.00																								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	6	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	6	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		
H3337	001	0	1	01	01	H3337_001_0	6	2	Non-Preferred Generic	3	4	000100	3	2	110		01	100		1	31		90				1			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										1		3
H3342	019	0	1	04	01	H3342_019_0	12	5	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, Specialty Tier, Select Care Drugs												
H3342	019	0	1	04	01	H3342_019_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	019	0	1	04	01	H3342_019_0	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	019	0	1	04	01	H3342_019_0	12	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.90	27.00	54.00	81.00					.73	22.00	44.00	66.00					.73	22.00	44.00	44.00																		27.00				.79	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	019	0	1	04	01	H3342_019_0	12	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	019	0	1	04	01	H3342_019_0	12	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		2.00				.05	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	020	0	1	04	01	H3342_020_0	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	020	0	1	04	01	H3342_020_0	11	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					.50	15.00	30.00	45.00					.50	15.00	30.00	30.00																		20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	020	0	1	04	01	H3342_020_0	11	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	020	0	1	04	01	H3342_020_0	11	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	020	0	1	04	01	H3342_020_0	11	5	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, Specialty Tier, Select Care Drugs												
H3342	020	0	1	04	01	H3342_020_0	11	6	Select Care Drugs	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					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		2.00				.05	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3344	005	0	1	04	01	H3344_005_0	6	2	Non-Preferred Generic	3	4	000110	1	2	110		01	100		1	30		90				2			90				30		34	.26	8.00		20.00																								20.00																		8.00				.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3344	005	0	1	04	01	H3344_005_0	6	1	Preferred Generic	3	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										1		
H3344	005	0	1	04	01	H3344_005_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		34					2223.56	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	6	2	Non-Preferred Generic	1	4	000110	1	2	110		01	100		1	30		90				2			90				30		34	.26	8.00		20.00																								20.00																		8.00				.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	6	3	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				2			90				30		34	1.50	45.00		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	6	4	Non-Preferred Brand	1	4	100100	3	2	110		01	100		1	30		90				2			90				30		34	2.50	75.00		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	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												
H3347	005	0	1	01	01	H3347_005_0	7	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												
H3347	005	0	1	01	01	H3347_005_0	7	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	7	1	Generic	1	2	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	5.00		15.00																								12.50																		5.00				0.00	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	005	0	1	01	01	H3347_005_0	7	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	012	0	1	01	01	H3347_012_0	8	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	012	0	1	01	01	H3347_012_0	8	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	012	0	1	01	01	H3347_012_0	8	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												
H3347	012	0	1	01	01	H3347_012_0	8	1	Generic	1	2	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	5.00		15.00																								12.50																		5.00				0.00	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	013	0	1	01	01	H3347_013_0	9	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												
H3347	013	0	1	01	01	H3347_013_0	9	2	Preferred Brand	1	4	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	013	0	1	01	01	H3347_013_0	9	3	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	90.00		270.00																								225.00																		90.00				0.00	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	013	0	1	01	01	H3347_013_0	9	4	Specialty Tier	1	4	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	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																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	8	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	8	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	2.00		5.00																								5.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	8	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	2.00		5.00																								5.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_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																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	8	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		10.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	8	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	8	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_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																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	7	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_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		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	7	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		10.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	7	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	7	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	2.00		5.00																								5.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	8	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_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																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	8	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	2.00		5.00																								5.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_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																								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	8	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	8	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																								238.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	8	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												
H3359	036	0	1	01	01	H3359_036_0	8	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	036	0	1	01	01	H3359_036_0	8	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	036	0	1	01	01	H3359_036_0	8	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	036	0	1	01	01	H3359_036_0	8	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	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				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	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.46	14.00		42.00					.06	2.00		6.00												.46	14.00		42.00				.06	2.00		5.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.86	86.00		258.00												3.16	95.00		285.00				2.86	86.00		215.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.13	34.00		102.00												1.50	45.00		135.00				1.13	34.00		85.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					.90	27.00		81.00												1.50	45.00		135.00				.90	27.00		67.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.30	69.00		207.00												3.16	95.00		285.00				2.30	69.00		172.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														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	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.46	14.00		42.00					.06	2.00		6.00												.46	14.00		42.00				.06	2.00		5.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_0	7	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_0	7	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					2.80	84.00		252.00												3.16	95.00		285.00				2.80	84.00		210.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_0	7	1	Preferred Generic	1	4	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												0.10	3.00		9.00				0.10	3.00		0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.56	17.00		51.00					0.46	14.00		42.00												0.56	17.00		51.00				0.46	14.00		35.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_0	7	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					1.46	44.00		132.00												1.50	45.00		135.00				1.46	44.00		110.00				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	8	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		12.00												0.13	4.00		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_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					2.80	84.00		252.00												3.16	95.00		285.00				2.80	84.00		210.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.56	17.00		51.00					0.46	14.00		42.00												0.56	17.00		51.00				0.46	14.00		35.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_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					1.43	43.00		129.00												1.50	45.00		135.00				1.43	43.00		107.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	8	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									1.06	32.00		96.00					.10	3.00		9.00												1.06	32.00		96.00				.10	3.00		7.50				32.00				1.03	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	8	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					0.00	0.00		0.00												0.00	0.00		0.00				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	8	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	8	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	8	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														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	7	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					.20	6.00		18.00												.33	10.00		30.00				.20	6.00		0.00				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	7	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					.96	29.00		87.00												1.10	33.00		99.00				.96	29.00		72.50				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	7	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	7	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					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	7	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_0	7	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.20	6.00		18.00					0.03	1.00		3.00												0.20	6.00		18.00				0.03	1.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.56	17.00		51.00					0.46	14.00		42.00												0.56	17.00		51.00				0.46	14.00		35.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_0	7	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					1.43	43.00		129.00												1.50	45.00		135.00				1.43	43.00		107.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_0	7	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					2.80	84.00		252.00												3.16	95.00		285.00				2.80	84.00		210.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_0	7	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	7	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.26	8.00		24.00					0.03	1.00		3.00												0.26	8.00		24.00				0.03	1.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	7	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					0.16	5.00		15.00												0.66	20.00		60.00				0.16	5.00		12.50				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	7	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					1.43	43.00		129.00												1.50	45.00		135.00				1.43	43.00		107.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	7	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					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	7	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	017	0	1	02	01	H3362_017_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												
H3362	017	0	1	02	01	H3362_017_0	6	2	Non-Preferred Generic	1	4	000110	1	2	110		01	100		1	30		90				2			90				30		34	.26	8.00		20.00																								20.00																		8.00				.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	017	0	1	02	01	H3362_017_0	6	2	Non-Preferred Generic	3	4	000110	1	2	110		01	100		1	30		90				2			90				30		34	.26	8.00		20.00																								20.00																		8.00				.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3362	017	0	1	02	01	H3362_017_0	6	1	Preferred Generic	3	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										1		
H3362	017	0	1	02	01	H3362_017_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		34					952.93	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	017	0	1	02	01	H3362_017_0	6	4	Non-Preferred Brand	1	4	100100	3	2	110		01	100		1	30		90				2			90				30		34	2.50	75.00		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	02	01	H3362_017_0	6	3	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				2			90				30		34	1.50	45.00		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	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												
H3362	020	0	1	01	01	H3362_020_0	6	4	Non-Preferred Brand	1	4	100100	3	1	110		01	100		1	30		90				2			90				30		34					64.92	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	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		34					158.21	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	3	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										1		
H3362	020	0	1	01	01	H3362_020_0	6	3	Preferred Brand	1	4	000001	3	1	110		01	100		1	30		90				2			90				30		34					56.12	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	2	Non-Preferred Generic	1	4	000110	1	2	110		01	100		1	30		90				2			90				30		34	.16	5.00		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	110		01	100		1	30		90				2			90				30		34	.16	5.00		12.50																								12.50																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3362	026	0	1	02	01	H3362_026_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												
H3362	026	0	1	02	01	H3362_026_0	6	2	Non-Preferred Generic	1	4	000110	1	2	110		01	100		1	30		90				2			90				30		34	0.33	10.00		25.00																								25.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	026	0	1	02	01	H3362_026_0	6	3	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				2			90				30		34	1.50	45.00		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	6	4	Non-Preferred Brand	1	4	100100	3	2	110		01	100		1	30		90				2			90				30		34	3.16	95.00		237.50																								237.50																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	026	0	1	02	01	H3362_026_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		34					961.15	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	026	0	1	02	01	H3362_026_0	6	1	Preferred Generic	3	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										1		
H3362	026	0	1	02	01	H3362_026_0	6	2	Non-Preferred Generic	3	4	000110	1	2	110		01	100		1	30		90				2			90				30		34	0.33	10.00		25.00																								25.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3362	027	0	1	01	01	H3362_027_0	7	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												
H3362	027	0	1	01	01	H3362_027_0	7	2	Non-Preferred Generic	1	4	000110	1	2	110		01	100		1	30		90				2			90				30		34	.26	8.00		20.00																								20.00																		8.00				.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	027	0	1	01	01	H3362_027_0	7	3	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				2			90				30		34	1.50	45.00		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	7	4	Non-Preferred Brand	1	4	100100	3	2	110		01	100		1	30		90				2			90				30		34	2.50	75.00		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	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		34					1303.54	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	027	0	1	01	01	H3362_027_0	7	1	Preferred Generic	3	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										1		
H3362	027	0	1	01	01	H3362_027_0	7	2	Non-Preferred Generic	3	4	000110	1	2	110		01	100		1	30		90				2			90				30		34	.26	8.00		20.00																								20.00																		8.00				.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3362	029	0	1	02	01	H3362_029_0	7	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												
H3362	029	0	1	02	01	H3362_029_0	7	2	Non-Preferred Generic	1	4	000110	1	2	110		01	100		1	30		90				2			90				30		34	0.33	10.00		25.00																								25.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	029	0	1	02	01	H3362_029_0	7	3	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				2			90				30		34	1.50	45.00		112.50																								112.50																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	029	0	1	02	01	H3362_029_0	7	4	Non-Preferred Brand	1	4	100100	3	2	110		01	100		1	30		90				2			90				30		34	3.00	90.00		225.00																								225.00																		90.00				2.64	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	029	0	1	02	01	H3362_029_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		34					961.15	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	029	0	1	02	01	H3362_029_0	7	1	Preferred Generic	3	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										1		
H3362	029	0	1	02	01	H3362_029_0	7	2	Non-Preferred Generic	3	4	000110	1	2	110		01	100		1	30		90				2			90				30		34	0.33	10.00		25.00																								25.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3370	028	0	1	01	01	H3370_028_0	8	5	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, Specialty Tier, Select Care Drugs												
H3370	028	0	1	01	01	H3370_028_0	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	028	0	1	01	01	H3370_028_0	8	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					1.03	31.00	62.00	93.00					1.03	31.00	93.00	93.00																		31.00				.91	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	028	0	1	01	01	H3370_028_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.16	5.00	10.00	15.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	028	0	1	01	01	H3370_028_0	8	2	Non-Preferred Generic	1	3	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	30.00					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	028	0	1	01	01	H3370_028_0	8	6	Select Care Drugs	1	3	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												
H3370	029	1	1	01	01	H3370_029_1	11	5	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, Specialty Tier, Select Care Drugs												
H3370	029	1	1	01	01	H3370_029_1	11	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	1	1	01	01	H3370_029_1	11	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	1	1	01	01	H3370_029_1	11	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.90	27.00	54.00	81.00					.73	22.00	44.00	66.00					.73	22.00	44.00	44.00																		27.00				.79	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	1	1	01	01	H3370_029_1	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	1	1	01	01	H3370_029_1	11	6	Select Care Drugs	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					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		2.00				.05	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_2	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_2	11	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.90	27.00	54.00	81.00					.73	22.00	44.00	66.00					.73	22.00	44.00	44.00																		27.00				.79	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_2	11	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_2	11	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_2	11	5	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, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_2	11	6	Select Care Drugs	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					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		2.00				.05	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_3	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_3	11	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.90	27.00	54.00	81.00					.73	22.00	44.00	66.00					.73	22.00	44.00	44.00																		27.00				.79	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_3	11	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_3	11	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_3	11	5	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, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_3	11	6	Select Care Drugs	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					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		2.00				.05	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	4	1	01	01	H3370_029_4	11	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.90	27.00	54.00	81.00					.73	22.00	44.00	66.00					.73	22.00	44.00	44.00																		27.00				.79	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	4	1	01	01	H3370_029_4	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	4	1	01	01	H3370_029_4	11	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	4	1	01	01	H3370_029_4	11	6	Select Care Drugs	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					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		2.00				.05	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	4	1	01	01	H3370_029_4	11	5	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, Specialty Tier, Select Care Drugs												
H3370	029	4	1	01	01	H3370_029_4	11	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	030	0	1	01	01	H3370_030_0	11	5	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, Specialty Tier, Select Care Drugs												
H3370	030	0	1	01	01	H3370_030_0	11	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	030	0	1	01	01	H3370_030_0	11	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	030	0	1	01	01	H3370_030_0	11	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.10	33.00	66.00	99.00					0.93	28.00	56.00	84.00					.93	28.00	56.00	56.00																		33.00				.97	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	030	0	1	01	01	H3370_030_0	11	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	030	0	1	01	01	H3370_030_0	11	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		2.00				0.05	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	12	5	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, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	12	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.90	27.00	54.00	81.00					.73	22.00	44.00	66.00					.73	22.00	44.00	44.00																		27.00				.79	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	12	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	12	6	Select Care Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		2.00				.05	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_0	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_0	11	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.93	28.00	56.00	84.00					.76	23.00	46.00	69.00					.76	23.00	46.00	46.00																		28.00				.82	28.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_0	11	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_0	11	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_0	11	5	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, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_0	11	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.16	5.00	10.00	15.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3379	001	0	1	01	01	H3379_001_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	3	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							275.00				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	3	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							125.00				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	3	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																															27.00							18.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					651.00	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	7	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	0.17	5.00		15.00																					0.17	5.00		12.50																			5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.50	15.00		45.00																					0.50	15.00		37.50																			15.00			0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					34.00	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	7	4	Non-Preferred Brand	1	4	100000	1	2	110		10	110		1	30		90				2	30		90					29	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												
H3384	013	0	1	01	01	H3384_013_0	7	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	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												
H3384	019	0	1	01	01	H3384_019_0	7	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	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												
H3384	019	0	1	01	01	H3384_019_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		10	110		1	30		90				2	30		90					29	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												
H3384	019	0	1	01	01	H3384_019_0	7	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					34.00	33		33																					33		33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.67	20.00		60.00																					0.67	20.00		50.00																			20.00			0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	7	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	0.23	7.00		21.00																					0.23	7.00		17.50																			7.00			0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	7	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					34.00	33		33																					33		33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		10	110		1	30		90				2	30		90					29	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												
H3384	057	0	1	02	01	H3384_057_0	7	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	0.23	7.00		21.00																					0.23	7.00		17.50																			7.00			0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.67	20.00		60.00																					0.67	20.00		50.00																			20.00			0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	7	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	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												
H3384	058	0	1	01	01	H3384_058_0	8	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	0.33	10.00		30.00																					0.33	10.00		25.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		10	110		1	30		90				2	30		90					29	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												
H3384	058	0	1	01	01	H3384_058_0	8	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					34.00	33		33																					33		33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.83	25.00		75.00																					0.83	25.00		62.50																			25.00			0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	8	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	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												
H3384	059	0	1	02	01	H3384_059_0	7	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					34.00	33		33																					33		33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		10	110		1	30		90				2	30		90					29	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												
H3384	059	0	1	02	01	H3384_059_0	7	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	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												
H3384	059	0	1	02	01	H3384_059_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.83	25.00		75.00																					0.83	25.00		62.50																			25.00			0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	7	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	0.33	10.00		30.00																					0.33	10.00		25.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.36	11.00		33.00																					0.36	11.00		22.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3388	002	0	1	01	01	H3388_002_0	9	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	9	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	9	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	002	0	1	01	01	H3388_002_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					965.79	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.36	11.00		33.00																					0.36	11.00		22.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	9	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	7	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	7	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	7	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												
H3388	004	0	1	01	01	H3388_004_0	7	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	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					951.91	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_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	013	0	1	01	01	H3388_013_0	8	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																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_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												
H3388	013	0	1	01	01	H3388_013_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					951.91	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_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												
H3404	001	0	1	04	01	H3404_001_0	10	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	001	0	1	04	01	H3404_001_0	10	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									3.16	95.00	190.00	285.00					2.66	80.00	160.00	240.00												3.16	95.00	190.00	285.00				2.66	80.00	160.00	200.00				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	10	3	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					1.33	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												
H3404	001	0	1	04	01	H3404_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									0.83	25.00	50.00	75.00					0.20	6.00	12.00	18.00												0.83	25.00	50.00	75.00				0.20	6.00	12.00	15.00				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	10	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.26	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.26	8.00	16.00	24.00				0.10	3.00	0.00	0.00				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	9	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	9	1	Preferred Generic	3	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.26	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.26	8.00	16.00	24.00				0.10	3.00	0.00	0.00				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	9	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									3.16	95.00	190.00	285.00					2.33	70.00	140.00	210.00												3.16	95.00	190.00	285.00				2.33	70.00	140.00	175.00				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	9	3	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					1.00	30.00	60.00	90.00												1.50	45.00	90.00	135.00				1.00	30.00	60.00	75.00				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	9	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.26	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.26	8.00	16.00	24.00				0.10	3.00	0.00	0.00				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	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					0.20	6.00	12.00	18.00												0.66	20.00	40.00	60.00				0.20	6.00	12.00	15.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3421	002	0	1	09	04	H3421_002_0	9	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	.13	4.00		12.00																					.13	4.00		10.00																		4.00				.12	4.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3421	002	0	1	09	04	H3421_002_0	9	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												
H3421	002	0	1	09	04	H3421_002_0	9	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	9	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												
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									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
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									0.16	5.00		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, 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									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	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									3.06	95.00		285.00					2.74	85.00		255.00								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													491.00	33							491.00	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	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																		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									0.16	5.00		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, Select Care Drugs										1		
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									0.16	5.00		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, 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									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
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									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H3447	003	0	1	01	01	H3447_003_0	8	6	Select Care Drugs	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																		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	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	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					2.74	85.00		255.00								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	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H3447	004	0	1	01	01	H3447_004_0	8	6	Select Care Drugs	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																		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	8	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H3447	004	0	1	01	01	H3447_004_0	8	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					2.74	85.00		255.00								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	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.32	10.00		30.00					0.16	5.00		15.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.50	15.50		46.50					.33	10.50		31.50								26.25																		15.50				.50	15.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	8	6	Select Care Drugs	1	4	010010	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	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	8	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					2.90	90.00		270.00								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	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3449	005	0	1	01	01	H3449_005_0	9	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.26	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.26	8.00	16.00	24.00				0.10	3.00	0.00	0.00				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	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					0.20	6.00	12.00	18.00												0.66	20.00	40.00	60.00				0.20	6.00	12.00	15.00				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	9	3	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					1.00	30.00	60.00	90.00												1.50	45.00	90.00	135.00				1.00	30.00	60.00	75.00				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	9	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									3.16	95.00	190.00	285.00					2.33	70.00	140.00	210.00												3.16	95.00	190.00	285.00				2.33	70.00	140.00	175.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	005	0	1	01	01	H3449_005_0	9	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	9	1	Preferred Generic	3	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.26	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.26	8.00	16.00	24.00				0.10	3.00	0.00	0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3449	013	0	1	01	01	H3449_013_0	9	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.26	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.26	8.00	16.00	24.00				.10	3.00	0.00	0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	013	0	1	01	01	H3449_013_0	9	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.83	25.00	50.00	75.00					0.20	6.00	12.00	18.00												0.83	25.00	50.00	75.00				0.20	6.00	12.00	15.00				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	9	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	9	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									3.16	95.00	190.00	285.00					2.66	80.00	160.00	240.00												3.16	95.00	190.00	285.00				2.66	80.00	160.00	200.00				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	9	3	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					1.33	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												
H3449	016	0	1	01	01	H3449_016_0	8	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									3.16	95.00	190.00	285.00					2.66	80.00	160.00	240.00												3.16	95.00	190.00	285.00				2.66	80.00	160.00	200.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	016	0	1	01	01	H3449_016_0	8	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.26	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.26	8.00	16.00	24.00				.10	3.00	0.00	0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	016	0	1	01	01	H3449_016_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.83	25.00	50.00	75.00					0.20	6.00	12.00	18.00												0.83	25.00	50.00	75.00				0.20	6.00	12.00	15.00				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	016	0	1	01	01	H3449_016_0	8	3	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					1.33	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												
H3449	016	0	1	01	01	H3449_016_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												
H3456	001	0	1	01	01	H3456_001_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	001	0	1	01	01	H3456_001_0	2	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							125.00				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	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					712.00	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	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	023	0	1	01	01	H3456_023_0	2	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							125.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					669.00	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	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	026	0	1	01	01	H3456_026_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	026	0	1	01	01	H3456_026_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	026	0	1	01	01	H3456_026_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	026	0	1	01	01	H3456_026_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	026	0	1	01	01	H3456_026_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					712.00	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	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.26	8.00		24.00					0.00	0.00		0.00					.26	8.00		24.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	3	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					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	3	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												
H3471	001	0	1	01	01	H3471_001_0	3	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												
H3471	001	0	1	01	01	H3471_001_0	3	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	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.26	8.00		24.00					0.00	0.00		0.00					.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	3	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					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	3	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												
H3471	002	0	1	01	01	H3471_002_0	3	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												
H3471	002	0	1	01	01	H3471_002_0	3	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	32		32					1.00	32		32					32		32																	32				32	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3480	001	0	1	48	05	H3480_001_0	9	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	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
H3480	001	0	1	48	05	H3480_001_0	9	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	0.00	2.65	0.00	2.65	0.00	2.65	0.00	2.65			
H3480	001	0	1	48	05	H3480_001_0	9	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	9	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			
H3528	001	0	1	01	01	H3528_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									0.83	25.00	50.00	75.00					0.47	14.00	28.00	42.00					.47	14.00	28.00	28.00																		25.00				.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	001	0	1	01	01	H3528_001_0	6	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	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												
H3528	001	0	1	01	01	H3528_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	270.00					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	6	3	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					1.33	40.00	80.00	120.00					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	001	0	1	01	01	H3528_001_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	8.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		9.00				.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	6	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	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												
H3528	002	0	1	01	01	H3528_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	270.00					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	6	3	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					1.33	40.00	80.00	120.00					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	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.63	19.00	38.00	57.00					0.47	14.00	28.00	42.00					.47	14.00	28.00	28.00																		19.00				.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	6	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.63	19.00	38.00	57.00					.47	14.00	28.00	42.00					.47	14.00	28.00	28.00																		19.00				.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	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	8.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.63	19.00	38.00	57.00					0.47	14.00	28.00	42.00					.47	14.00	28.00	28.00																		19.00				.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	8.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	6	3	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					1.33	40.00	80.00	120.00					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	6	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.63	19.00	38.00	57.00					.47	14.00	28.00	42.00					.47	14.00	28.00	28.00																		19.00				.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3528	006	0	1	02	01	H3528_006_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		9.00				.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	6	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	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												
H3528	006	0	1	02	01	H3528_006_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	270.00					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	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	8.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	008	0	1	02	01	H3528_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									.83	25.00	50.00	75.00					0.47	14.00	28.00	42.00					.47	14.00	28.00	28.00																		25.00				.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	008	0	1	02	01	H3528_008_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.50	45.00	90.00	135.00					1.33	40.00	80.00	120.00					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	008	0	1	02	01	H3528_008_0	8	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	270.00					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	8	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	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												
H3533	001	0	1	01	01	H3533_001_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		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												
H3533	001	0	1	01	01	H3533_001_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		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												
H3533	001	0	1	01	01	H3533_001_0	3	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	3	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	3	5	Specialty Tier	1	3	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												
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	5	Specialty Tier	1	3	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												
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	2.66	80.00		240.00																												2.66	80.00		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												
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	1.00	30.00		90.00																												1.00	30.00		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												
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	0.30	9.00		27.00																												0.30	9.00		27.00				0.30	9.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.46	14.00		42.00																												0.46	14.00		42.00				0.46	14.00		0.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_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	004	0	1	01	01	H3533_004_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	004	0	1	01	01	H3533_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		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												
H3533	004	0	1	01	01	H3533_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		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												
H3533	005	0	1	01	01	H3533_005_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	005	0	1	01	01	H3533_005_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	005	0	1	01	01	H3533_005_0	3	5	Specialty Tier	1	4	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												
H3533	005	0	1	01	01	H3533_005_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		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												
H3533	005	0	1	01	01	H3533_005_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		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												
H3533	005	0	1	01	01	H3533_005_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	005	0	1	01	01	H3533_005_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	005	0	1	01	01	H3533_005_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		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										2	3	
H3533	005	0	1	01	01	H3533_005_0	3	5	Specialty Tier	3	4	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										2	3	
H3533	005	0	1	01	01	H3533_005_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		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										2	3	
H3533	006	0	1	01	01	H3533_006_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_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		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												
H3533	006	0	1	01	01	H3533_006_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		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												
H3533	006	0	1	01	01	H3533_006_0	3	5	Specialty Tier	3	4	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										2	3	
H3533	006	0	1	01	01	H3533_006_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		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										2	3	
H3533	006	0	1	01	01	H3533_006_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		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										2	3	
H3533	006	0	1	01	01	H3533_006_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	006	0	1	01	01	H3533_006_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		54.00				0.60	18.00		0.00				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	3	5	Specialty Tier	1	4	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												
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		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												
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		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												
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						25																														25							25					25				25	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	0.26	8.00		24.00																												0.26	8.00		24.00				0.26	8.00		0.00				8.00				0.25	8.00		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	0.60	18.00		54.00																												0.60	18.00		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	007	0	1	01	01	H3533_007_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		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										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		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										2	3	
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						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	0.26	8.00		24.00																												0.26	8.00		24.00				0.26	8.00		0.00				8.00				0.25	8.00		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	0.60	18.00		54.00																												0.60	18.00		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	009	0	1	01	01	H3533_009_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		270.00				3.00	90.00		260.00				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	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		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												
H3533	009	0	1	01	01	H3533_009_0	3	5	Specialty Tier	3	4	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										2	3	
H3533	009	0	1	01	01	H3533_009_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		270.00				3.00	90.00		260.00				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	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		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										2	3	
H3533	009	0	1	01	01	H3533_009_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	009	0	1	01	01	H3533_009_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	009	0	1	01	01	H3533_009_0	3	5	Specialty Tier	1	4	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												
H3533	009	0	1	01	01	H3533_009_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	009	0	1	01	01	H3533_009_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	0.33	10.00		30.00																												0.33	10.00		30.00				0.33	10.00		0.00				10.00				0.32	10.00		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	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		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										2	3	
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		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										2	3	
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	0.83	25.00		75.00																												0.83	25.00		75.00				0.83	25.00		0.00				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	010	0	1	01	01	H3533_010_0	4	5	Specialty Tier	3	4	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										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						25																														25							25					25				25	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		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												
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		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												
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	0.83	25.00		75.00																												0.83	25.00		75.00				0.83	25.00		0.00				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	0.33	10.00		30.00																												0.33	10.00		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	013	0	1	01	01	H3533_013_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		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												
H3533	013	0	1	01	01	H3533_013_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		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												
H3533	013	0	1	01	01	H3533_013_0	3	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.46	14.00		42.00																												0.46	14.00		42.00				0.46	14.00		0.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_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												
H3533	013	0	1	01	01	H3533_013_0	3	5	Specialty Tier	1	3	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												
H3533	016	0	1	01	01	H3533_016_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	016	0	1	01	01	H3533_016_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	016	0	1	01	01	H3533_016_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		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												
H3533	016	0	1	01	01	H3533_016_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		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												
H3533	016	0	1	01	01	H3533_016_0	3	5	Specialty Tier	3	4	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										2	3	
H3533	016	0	1	01	01	H3533_016_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	016	0	1	01	01	H3533_016_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	016	0	1	01	01	H3533_016_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		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										2	3	
H3533	016	0	1	01	01	H3533_016_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		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										2	3	
H3533	016	0	1	01	01	H3533_016_0	3	5	Specialty Tier	1	4	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												
H3533	017	0	1	01	01	H3533_017_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	017	0	1	01	01	H3533_017_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	017	0	1	01	01	H3533_017_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		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												
H3533	017	0	1	01	01	H3533_017_0	3	5	Specialty Tier	3	4	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										2	3	
H3533	017	0	1	01	01	H3533_017_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		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										2	3	
H3533	017	0	1	01	01	H3533_017_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		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										2	3	
H3533	017	0	1	01	01	H3533_017_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	017	0	1	01	01	H3533_017_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		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												
H3533	017	0	1	01	01	H3533_017_0	3	5	Specialty Tier	1	4	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												
H3533	017	0	1	01	01	H3533_017_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	018	0	1	01	01	H3533_018_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	018	0	1	01	01	H3533_018_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		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												
H3533	018	0	1	01	01	H3533_018_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		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												
H3533	018	0	1	01	01	H3533_018_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.46	14.00		42.00																												0.46	14.00		42.00				0.46	14.00		0.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	018	0	1	01	01	H3533_018_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	019	0	1	01	01	H3533_019_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	019	0	1	01	01	H3533_019_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	019	0	1	01	01	H3533_019_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		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												
H3533	019	0	1	01	01	H3533_019_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		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												
H3533	019	0	1	01	01	H3533_019_0	3	5	Specialty Tier	1	4	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												
H3533	019	0	1	01	01	H3533_019_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	019	0	1	01	01	H3533_019_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	019	0	1	01	01	H3533_019_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		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										2	3	
H3533	019	0	1	01	01	H3533_019_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		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										2	3	
H3533	019	0	1	01	01	H3533_019_0	3	5	Specialty Tier	3	4	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										2	3	
H3536	002	0	1	01	01	H3536_002_0	13	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_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									.73	22.00	44.00	66.00					.56	17.00	34.00	51.00					.56	17.00	34.00	34.00																		22.00				.64	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	13	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	13	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	13	5	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, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	13	6	Select Care Drugs	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					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		2.00				.05	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3597	001	0	1	01	01	H3597_001_0	4	3	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	135.00												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												
H3597	001	0	1	01	01	H3597_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.43	13.00	26.00	39.00					0.30	9.00	18.00	27.00												0.43	13.00	26.00	39.00				0.30	9.00	18.00	27.00					13.00			0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													40.92	50	50	50					37.60	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	002	0	1	01	01	H3597_002_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	8.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	8.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	002	0	1	01	01	H3597_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.43	13.00	26.00	26.00					0.30	9.00	18.00	18.00												0.43	13.00	26.00	26.00				0.30	9.00	18.00	18.00					13.00			0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	002	0	1	01	01	H3597_002_0	4	3	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	135.00												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												
H3597	002	0	1	01	01	H3597_002_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													43.76	50	50	50					41.58	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	002	0	1	01	01	H3597_002_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	005	0	1	01	01	H3597_005_0	3	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	8.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	8.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H3597	005	0	1	01	01	H3597_005_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.43	13.00	26.00	26.00					0.30	9.00	18.00	18.00												0.43	13.00	26.00	26.00				0.30	9.00	18.00	18.00					13.00			0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H3597	005	0	1	01	01	H3597_005_0	3	3	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	135.00												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												
H3597	005	0	1	01	01	H3597_005_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													44.05	50	50	50					42.16	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H3623	001	0	1	01	01	H3623_001_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	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	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.18	50	50	50					36.32	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	001	0	1	01	01	H3623_001_0	5	3	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	135.00												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												
H3623	001	0	1	01	01	H3623_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.46	14.00	28.00	42.00					.33	10.00	20.00	30.00												.46	14.00	28.00	42.00				.33	10.00	20.00	30.00					14.00			.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	001	0	1	01	01	H3623_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	001	0	1	01	01	H3623_001_0	5	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3623	004	0	1	01	01	H3623_004_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	004	0	1	01	01	H3623_004_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													36.42	50	50	50					33.78	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	004	0	1	01	01	H3623_004_0	5	3	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	135.00												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												
H3623	004	0	1	01	01	H3623_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.46	14.00	28.00	42.00					.33	10.00	20.00	30.00												.46	14.00	28.00	42.00				.33	10.00	20.00	30.00					14.00			.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	004	0	1	01	01	H3623_004_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	004	0	1	01	01	H3623_004_0	5	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3623	018	0	1	01	01	H3623_018_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	018	0	1	01	01	H3623_018_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.36	11.00	22.00	33.00					.23	7.00	14.00	21.00												.36	11.00	22.00	33.00				.23	7.00	14.00	21.00					11.00			.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	018	0	1	01	01	H3623_018_0	4	3	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	135.00												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												
H3623	018	0	1	01	01	H3623_018_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													32.00	50	50	50					31.18	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	018	0	1	01	01	H3623_018_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	018	0	1	01	01	H3623_018_0	4	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3623	020	0	1	01	01	H3623_020_0	3	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	020	0	1	01	01	H3623_020_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.43	13.00	26.00	39.00					.30	9.00	18.00	27.00												.43	13.00	26.00	39.00				.30	9.00	18.00	27.00					13.00			.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	020	0	1	01	01	H3623_020_0	3	3	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	135.00												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												
H3623	020	0	1	01	01	H3623_020_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.08	50	50	50					36.94	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	020	0	1	01	01	H3623_020_0	3	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	020	0	1	01	01	H3623_020_0	3	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3653	004	0	1	01	01	H3653_004_0	9	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, Injectable Drugs, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.26	8.00		24.00																								16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	9	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, Injectable Drugs, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	9	4	Injectable Drugs	1	4	010010	1	1	010		01			1	30													30		31					55.21	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	9	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1571.44	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	8	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1736.81	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	8	4	Injectable Drugs	1	4	010010	1	1	010		01			1	30													30		31					74.72	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_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																								80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	8	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, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	8	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, Injectable Drugs, Specialty Tier												
H3655	032	0	1	01	01	H3655_032_0	10	6	Select Care Drugs	1	3	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												
H3655	032	0	1	01	01	H3655_032_0	10	5	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, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	10	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	10	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.83	25.00	50.00	75.00					0.66	20.00	40.00	60.00					0.66	20.00	40.00	40.00																		25.00				0.73	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.40	42.00	84.00	126.00					1.23	37.00	74.00	111.00					1.23	37.00	111.00	111.00																		42.00				1.23	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	11	5	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, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	11	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	11	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					1.03	31.00	62.00	93.00					1.03	31.00	93.00	93.00																		31.00				0.91	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	11	2	Non-Preferred Generic	1	3	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	30.00					0.33	10.00	20.00	20.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	11	1	Preferred Generic	1	3	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	15.00					0.16	5.00	10.00	10.00																		5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	11	6	Select Care Drugs	1	3	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												
H3655	034	0	1	01	01	H3655_034_0	11	6	Select Care Drugs	1	3	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												
H3655	034	0	1	01	01	H3655_034_0	11	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	11	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.86	26.00	52.00	78.00					0.70	21.00	42.00	63.00					0.70	21.00	42.00	42.00																		26.00				0.76	26.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	11	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	11	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	11	5	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, Specialty Tier, Select Care Drugs												
H3659	003	0	1	01	01	H3659_003_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					785.00	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	2	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							275.00				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	2	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							125.00				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	2	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																															24.00							16.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	031	0	1	01	01	H3659_031_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					638.00	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	031	0	1	01	01	H3659_031_0	2	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																															24.00							16.00				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	2	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							125.00				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	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	062	0	1	01	01	H3659_062_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					647.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	062	0	1	01	01	H3659_062_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	062	0	1	01	01	H3659_062_0	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	062	0	1	01	01	H3659_062_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	062	0	1	01	01	H3659_062_0	2	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							275.00				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	14	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	14	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	14	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		30.00																								25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	028	0	1	02	01	H3660_028_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																								0.00																		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	14	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	15	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	15	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	15	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	15	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	029	0	1	02	01	H3660_029_0	15	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	044	0	1	01	01	H3660_044_0	15	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	15	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	15	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		30.00																								25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	044	0	1	01	01	H3660_044_0	15	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	15	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	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		30.00																								25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	047	0	1	01	01	H3660_047_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																								0.00																		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	13	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	13	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	13	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	13	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	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																								0.00																		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	13	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	048	0	1	02	01	H3660_048_0	13	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	13	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	049	0	1	01	01	H3660_049_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																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	049	0	1	01	01	H3660_049_0	13	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	049	0	1	01	01	H3660_049_0	13	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	049	0	1	01	01	H3660_049_0	13	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	049	0	1	01	01	H3660_049_0	13	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	050	0	1	01	01	H3660_050_0	8	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	050	0	1	01	01	H3660_050_0	8	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	050	0	1	01	01	H3660_050_0	8	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	050	0	1	01	01	H3660_050_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												
H3660	050	0	1	01	01	H3660_050_0	8	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												
H3664	017	0	1	02	01	H3664_017_0	6	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	6	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	6	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	24.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_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												
H3664	017	0	1	02	01	H3664_017_0	6	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1598.43	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	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.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												
H3664	020	0	1	02	01	H3664_020_0	4	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	24.00																		8.00				.25	8.00		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	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	020	0	1	02	01	H3664_020_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	020	0	1	02	01	H3664_020_0	4	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1603.97	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	4	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												
H3664	021	0	1	02	01	H3664_021_0	4	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1670.35	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_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	021	0	1	02	01	H3664_021_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	021	0	1	02	01	H3664_021_0	4	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	45.00																					.50	15.00	30.00	45.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	5	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	5	2	Non-Preferred Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.50	15.00	30.00	45.00																					0.50	15.00	30.00	30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	5	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	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	005	0	1	01	01	H3668_005_0	5	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	005	0	1	01	01	H3668_005_0	5	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	5	2	Non-Preferred Generic	3	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.50	15.00	30.00	45.00																					0.50	15.00	30.00	30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	011	0	1	01	01	H3668_011_0	4	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	180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_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												
H3668	011	0	1	01	01	H3668_011_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												
H3668	011	0	1	01	01	H3668_011_0	4	1	Preferred Generic	1	4	001001	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	8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_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	011	0	1	01	01	H3668_011_0	4	1	Preferred Generic	3	4	001001	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	8.00																		4.00				0.13	4.00		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	0.50	15.00	30.00	45.00																					0.50	15.00	30.00	30.00																		15.00				0.48	15.00		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	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	2	Non-Preferred Generic	3	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.50	15.00	30.00	45.00																					0.50	15.00	30.00	30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	015	0	1	01	01	H3668_015_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	015	0	1	01	01	H3668_015_0	4	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	180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_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												
H3668	015	0	1	01	01	H3668_015_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												
H3668	015	0	1	01	01	H3668_015_0	4	1	Preferred Generic	1	4	001001	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	8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	4	1	Preferred Generic	3	4	001001	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	8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	0.50	15.00	30.00	45.00																					0.50	15.00	30.00	30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	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	0.50	15.00	30.00	45.00																					0.50	15.00	30.00	30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	017	0	1	01	01	H3668_017_0	4	1	Preferred Generic	1	4	001001	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	8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_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												
H3668	017	0	1	01	01	H3668_017_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												
H3668	017	0	1	01	01	H3668_017_0	4	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	180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_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	017	0	1	01	01	H3668_017_0	4	1	Preferred Generic	3	4	001001	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	8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3672	013	0	1	01	01	H3672_013_0	5	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	5	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	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																								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	5	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	5	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	5	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	018	0	1	01	01	H3672_018_0	4	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	4	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	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																								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	4	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	4	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	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		12.50				.17	5.00		5.00				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_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		30.00				.40	12.00		12.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_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												
H3706	001	0	1	01	01	H3706_001_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		237.50				3.17	95.00		95.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_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		112.50				1.50	45.00		45.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	2	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							125.00				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	2	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				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	2	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							275.00				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	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	2	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																															24.00							16.00				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	2	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							125.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					787.00	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	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	2	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				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	2	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							275.00				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	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																					2.11	95.00	190.00	190.00																		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	9	5	Specialty Tier	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					413.01	33	33	33																					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	9	6	Injectable Drugs	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					25.02	33	33	33																					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	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																					0.89	40.00	80.00	80.00																		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	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.40	12.00	24.00	36.00																					0.27	12.00	24.00	24.00																		12.00				0.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	001	0	1	01	01	H3755_001_0	9	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, Injectable Drugs												
H3755	004	0	1	01	01	H3755_004_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																					2.11	95.00	190.00	190.00																		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	8	5	Specialty Tier	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					489.28	33	33	33																					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	8	6	Injectable Drugs	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					25.26	33	33	33																					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	8	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																					0.89	40.00	80.00	80.00																		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	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.40	12.00	24.00	36.00																					0.27	12.00	24.00	24.00																		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	8	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, Injectable Drugs												
H3755	005	0	1	01	01	H3755_005_0	8	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																					0.89	40.00	80.00	80.00																		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	8	4	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	270.00																					2.00	90.00	180.00	180.00																		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	8	5	Specialty Tier	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					412.99	33	33	33																					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	8	6	Injectable Drugs	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					25.02	33	33	33																					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	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.17	5.00	10.00	15.00																					0.11	5.00	10.00	10.00																		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	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.43	13.00	26.00	39.00																					0.29	13.00	26.00	26.00																		13.00				0.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3765	001	0	1	01	01	H3765_001_0	12	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.06	2.00	4.00	5.00																					0.06	2.00	4.00	4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3765	001	0	1	01	01	H3765_001_0	12	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.32	10.00	20.00	25.00																					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												
H3765	001	0	1	01	01	H3765_001_0	12	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.12	35.00	70.00	87.50																					1.12	35.00	70.00	70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3765	001	0	1	01	01	H3765_001_0	12	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					99.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3765	001	0	1	01	01	H3765_001_0	12	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					1392.67	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3794	003	0	1	01	01	H3794_003_0	3	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							8.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3794	003	0	1	01	01	H3794_003_0	3	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.23	7.00		21.00																															21.00							14.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3794	003	0	1	01	01	H3794_003_0	3	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3794	003	0	1	01	01	H3794_003_0	3	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3794	003	0	1	01	01	H3794_003_0	3	5	Specialty Tier	1	3	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												
H3805	001	0	1	01	01	H3805_001_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	001	0	1	01	01	H3805_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																															135.00							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	001	0	1	01	01	H3805_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																															285.00							275.00				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	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					706.00	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	4	5	Specialty Tier	1	3	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												
H3805	007	0	1	01	01	H3805_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																															285.00							275.00				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	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	007	0	1	01	01	H3805_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	007	0	1	01	01	H3805_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																															135.00							125.00				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	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					507.00	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	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_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							125.00				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	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							275.00				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	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	013	0	1	01	01	H3805_013_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					864.00	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	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							275.00				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	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							125.00				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	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																															30.00							20.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	9	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	15.00				.16	5.00	10.00	0.00				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	9	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	45.00				.50	15.00	30.00	30.00				15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	9	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	30.00				.33	10.00	20.00	20.00				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	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	190.00																												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												
H3810	003	0	1	01	01	H3810_003_0	9	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	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	90.00																												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												
H3811	002	0	1	01	01	H3811_002_0	4	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	002	0	1	01	01	H3811_002_0	4	5	Specialty Tier	1	4	000001	1	1	010		01			1	34													34		31					68.51	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	4	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	4	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	4	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	4	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	4	5	Specialty Tier	1	4	000010	1	1	010		01			1	34													34		31					68.51	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	4	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	4	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	4	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	4	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		
H3811	009	0	1	01	01	H3811_009_0	4	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												
H3812	001	0	1	04	01	H3812_001_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3812	001	0	1	04	01	H3812_001_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3812	001	0	1	04	01	H3812_001_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					635.00	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	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							275.00				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	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	004	0	1	04	01	H3813_004_0	7	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	7	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	7	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	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	004	0	1	04	01	H3813_004_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	.38	12.00	24.00	36.00																					.38	12.00	24.00	36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	004	0	1	04	01	H3813_004_0	7	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	7	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	7	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	7	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	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	.38	12.00	24.00	36.00																					.38	12.00	24.00	36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	005	0	1	04	01	H3813_005_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	1.45	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												
H3813	006	0	1	04	01	H3813_006_0	8	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																					.06	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	8	5	Specialty Tier	1	4	100100	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	8	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	8	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	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	8	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																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	13	5	Injectable Drugs	1	4	100100	1	1	010		10			1	30														20	31					999.00	25																																											25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	13	4	Non-Preferred Brand	1	4	100000	3	2	111		10		111	1	30	60	90				1				30	60	90		20	31	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			2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	13	3	Preferred Brand	1	4	000001	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	1.00	30.00	60.00	90.00																												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, Injectable Drugs, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	13	2	Non-Preferred Generic	1	4	000100	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	.17	5.00	10.00	15.00																												.16	5.00	10.00	15.00				.16	5.00	10.00	10.00					5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	13	1	Preferred Generic	1	4	001000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	.10	3.00	6.00	9.00																												.10	3.00	6.00	9.00				.10	3.00	6.00	6.00					3.00			.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	13	6	Specialty Tier	1	4	100100	1	1	010		10			1	30														20	31					999.00	33																																											33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	11	5	Injectable Drugs	1	4	100100	1	1	010		10			1	30														20	31					999.00	25																																											25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	11	4	Non-Preferred Brand	1	4	100000	3	2	111		10		111	1	30	60	90				1				30	60	90		20	31	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			2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	11	3	Preferred Brand	1	4	000001	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	1.00	30.00	60.00	90.00																												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, Injectable Drugs, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	11	2	Non-Preferred Generic	1	4	000100	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	0.17	5.00	10.00	15.00																												0.17	5.00	10.00	15.00				0.17	5.00	10.00	10.00					5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	11	1	Preferred Generic	1	4	001000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	0.17	5.00	10.00	15.00																												0.17	5.00	10.00	15.00				0.17	5.00	10.00	10.00					5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	11	6	Specialty Tier	1	4	100100	1	1	010		10			1	30														20	31					999.00	33																																											33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	9	1	Preferred Generic	1	4	001000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				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												
H3815	007	0	1	01	01	H3815_007_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	0.17	5.00	10.00	15.00																												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, Injectable Drugs, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	9	3	Preferred Brand	1	4	000001	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	1.00	30.00	60.00	90.00																												1.00	30.00	60.00	90.00				1.00	30.00	60.00	60.00					30.00			0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	9	4	Non-Preferred Brand	1	4	100000	3	2	111		10		111	1	30	60	90				1				30	60	90		20	31	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			2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	9	5	Injectable Drugs	1	4	100100	1	1	010		10			1	30														20	31					999.99	25																																											25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	9	6	Specialty Tier	1	4	100100	1	1	010		10			1	30														20	31					999.99	33																																											33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	008	0	1	01	01	H3815_008_0	7	1	Preferred Generic	1	4	001000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				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												
H3815	008	0	1	01	01	H3815_008_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	.17	5.00	10.00	15.00																												.16	5.00	10.00	15.00				.16	5.00	10.00	10.00					5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	008	0	1	01	01	H3815_008_0	7	3	Preferred Brand	1	4	000001	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	1.00	30.00	60.00	90.00																												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, Injectable Drugs, Specialty Tier												
H3815	008	0	1	01	01	H3815_008_0	7	4	Non-Preferred Brand	1	4	100000	3	2	111		10		111	1	30	60	90				1				30	60	90		20	31	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			2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	008	0	1	01	01	H3815_008_0	7	5	Injectable Drugs	1	4	100100	1	1	010		10			1	30														20	31					999.00	25																																											25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	008	0	1	01	01	H3815_008_0	7	6	Specialty Tier	1	4	100100	1	1	010		10			1	30														20	31					999.00	33																																											33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3817	008	1	1	04	01	H3817_008_1	9	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.26	8.00		16.00																					0.26	8.00		16.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	008	1	1	04	01	H3817_008_1	9	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.50	15.00		30.00																					0.50	15.00		30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	008	1	1	04	01	H3817_008_1	9	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					1113.00	27																							27																			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	008	1	1	04	01	H3817_008_1	9	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	008	1	1	04	01	H3817_008_1	9	3	Preferred Brand	1	3	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												
H3817	008	2	1	04	01	H3817_008_2	9	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	9	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					1113.00	27																							27																			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	9	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.26	8.00		16.00																					0.26	8.00		16.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	9	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.50	15.00		30.00																					0.50	15.00		30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	9	3	Preferred Brand	1	3	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												
H3817	008	3	1	04	01	H3817_008_3	9	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.26	8.00		16.00																					0.26	8.00		16.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	008	3	1	04	01	H3817_008_3	9	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.50	15.00		30.00																					0.50	15.00		30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	008	3	1	04	01	H3817_008_3	9	3	Preferred Brand	1	3	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												
H3817	008	3	1	04	01	H3817_008_3	9	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	008	3	1	04	01	H3817_008_3	9	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					1113.00	27																							27																			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	009	1	1	04	01	H3817_009_1	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.40	12.00		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	009	1	1	04	01	H3817_009_1	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		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												
H3817	009	1	1	04	01	H3817_009_1	9	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												
H3817	009	1	1	04	01	H3817_009_1	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	009	1	1	04	01	H3817_009_1	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	009	2	1	04	01	H3817_009_2	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		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												
H3817	009	2	1	04	01	H3817_009_2	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.40	12.00		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	009	2	1	04	01	H3817_009_2	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	009	2	1	04	01	H3817_009_2	9	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												
H3817	009	2	1	04	01	H3817_009_2	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	009	3	1	04	01	H3817_009_3	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.40	12.00		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	009	3	1	04	01	H3817_009_3	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		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												
H3817	009	3	1	04	01	H3817_009_3	9	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												
H3817	009	3	1	04	01	H3817_009_3	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	009	3	1	04	01	H3817_009_3	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	13	2	Non-Preferred Generic	1	4	000101	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					6.07	25	25	25																					25	25	25																		25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	13	3	Preferred Brand	1	4	000101	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					23.67	25	25	25																					25	25	25																		25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	13	1	Preferred Generic	1	4	001001	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					0.00	0	0	0																					0	0	0																		0			0	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	13	1	Preferred Generic	3	4	001001	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					0.00	0	0	0																					0	0	0																		0			0	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3818	002	0	1	01	01	H3818_002_0	13	4	Non-Preferred Brand	1	4	100100	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					32.80	25	25	25																					25	25	25																		25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	13	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					10	31					360.40	25	25	25																					25	25	25																		25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	10	5	Specialty Tier	1	3	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					10	31					700.00	28	28	28																					28	28	28																		28			28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	10	4	Non-Preferred Brand	1	3	100100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	3.00	90.00	180.00	270.00																					3.00	90.00	90.00	90.00																			90.00			2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	10	3	Preferred Brand	1	3	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	1.17	35.00	70.00	105.00																					1.17	35.00	35.00	35.00																			35.00			1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	10	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	10	2	Non-Preferred Generic	1	3	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	.67	20.00	40.00	60.00																					.67	20.00	20.00	20.00																			20.00			.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	014	0	1	01	01	H3818_014_0	11	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	70.00	70.00																			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	11	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	30.00	30.00																			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	11	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	7.00	7.00																			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	11	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	11	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	13	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	001	0	1	01	01	H3822_001_0	13	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	13	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	13	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	13	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	13	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	13	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	002	0	1	01	01	H3822_002_0	16	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	002	0	1	01	01	H3822_002_0	16	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	16	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	16	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	16	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	16	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	16	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		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									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		44.00				1.41	44.00		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									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	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	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	003	0	1	01	01	H3822_003_0	11	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	005	0	1	02	01	H3822_005_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	10	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	005	0	1	02	01	H3822_005_0	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	005	0	1	02	01	H3822_005_0	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	10	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	005	0	1	02	01	H3822_005_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	005	0	1	02	01	H3822_005_0	10	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	007	0	1	02	01	H3822_007_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	10	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	10	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	007	0	1	02	01	H3822_007_0	10	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	008	0	1	02	01	H3822_008_0	11	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	11	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	11	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	11	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	008	0	1	02	01	H3822_008_0	11	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	11	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	008	0	1	02	01	H3822_008_0	11	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	10	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				2			90				30		34					323.30	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	10	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				2			90				30		34	0.36	11.00		33.00																								22.00																		11.00				0.32	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	10	3	Preferred Brand	1	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	10	4	Non-Preferred Brand	1	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	10	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				2			90				30		34	.15	4.50		13.50																								4.50																		4.50				.13	4.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	.13	4.00		12.00																								4.00																		4.00				.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3832	008	0	1	04	01	H3832_008_0	8	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		34					446.81	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	8	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		34	0.33	10.00		30.00																								20.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	.13	4.00		12.00																								4.00																		4.00				.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	9	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				2			90				30		34	.15	4.50		13.50																								4.50																		4.50				.13	4.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	9	3	Preferred Brand	1	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	9	4	Non-Preferred Brand	1	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	9	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				2			90				30		34					351.05	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	9	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				2			90				30		34	0.36	11.00		33.00																								22.00																		11.00				0.32	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	.13	4.00		12.00																								4.00																		4.00				.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	.13	4.00		12.00																								4.00																		4.00				.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3832	010	0	1	04	01	H3832_010_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		34					489.30	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	7	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	7	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		34	0.33	10.00		30.00																								20.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	006	0	1	01	01	H3864_006_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					0.06	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	006	0	1	01	01	H3864_006_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	006	0	1	01	01	H3864_006_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		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	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		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	7	4	Non-Preferred Brand	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	006	0	1	01	01	H3864_006_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					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		
H3864	006	0	1	01	01	H3864_006_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	006	0	1	01	01	H3864_006_0	7	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	006	0	1	01	01	H3864_006_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						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	30		90				2	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		285.00																		95.00				3.06	95.00		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	30		90				2	30		90				30		31	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												
H3864	014	0	1	01	01	H3864_014_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		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	30		90				2	30		90				30		31	0.06	2.00		6.00																					0.06	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	014	0	1	01	01	H3864_014_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						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	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	014	0	1	01	01	H3864_014_0	7	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	014	0	1	01	01	H3864_014_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	014	0	1	01	01	H3864_014_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					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		
H3864	015	0	1	01	01	H3864_015_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					0.06	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	015	0	1	01	01	H3864_015_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	015	0	1	01	01	H3864_015_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		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	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		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	7	4	Non-Preferred Brand	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	015	0	1	01	01	H3864_015_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	015	0	1	01	01	H3864_015_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					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		
H3864	015	0	1	01	01	H3864_015_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						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	7	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	016	0	1	01	01	H3864_016_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		285.00																		95.00				3.06	95.00		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	30		90				2	30		90				30		31	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												
H3864	016	0	1	01	01	H3864_016_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		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	30		90				2	30		90				30		31	0.06	2.00		6.00																					0.06	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	016	0	1	01	01	H3864_016_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						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	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	016	0	1	01	01	H3864_016_0	7	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	016	0	1	01	01	H3864_016_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	016	0	1	01	01	H3864_016_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					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		
H3864	019	0	1	01	01	H3864_019_0	9	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		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	9	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		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	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	019	0	1	01	01	H3864_019_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					0.06	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	019	0	1	01	01	H3864_019_0	9	4	Non-Preferred Brand	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	019	0	1	01	01	H3864_019_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					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		
H3864	019	0	1	01	01	H3864_019_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	019	0	1	01	01	H3864_019_0	9	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	019	0	1	01	01	H3864_019_0	9	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						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	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	020	0	1	01	01	H3864_020_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		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	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	020	0	1	01	01	H3864_020_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					0.06	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	020	0	1	01	01	H3864_020_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						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	7	4	Non-Preferred Brand	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	020	0	1	01	01	H3864_020_0	7	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	020	0	1	01	01	H3864_020_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	020	0	1	01	01	H3864_020_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					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		
H3864	021	0	1	01	01	H3864_021_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					0.06	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	021	0	1	01	01	H3864_021_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		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	30		90				2	30		90				30		31	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												
H3864	021	0	1	01	01	H3864_021_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		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	4	Non-Preferred Brand	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	021	0	1	01	01	H3864_021_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					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		
H3864	021	0	1	01	01	H3864_021_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	021	0	1	01	01	H3864_021_0	7	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	021	0	1	01	01	H3864_021_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	022	0	1	01	01	H3864_022_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	022	0	1	01	01	H3864_022_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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	022	0	1	01	01	H3864_022_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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	022	0	1	01	01	H3864_022_0	6	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	022	0	1	01	01	H3864_022_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	022	0	1	01	01	H3864_022_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	022	0	1	01	01	H3864_022_0	6	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	022	0	1	01	01	H3864_022_0	6	4	Non-Preferred Brand	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	022	0	1	01	01	H3864_022_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	023	0	1	01	01	H3864_023_0	8	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	023	0	1	01	01	H3864_023_0	8	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	023	0	1	01	01	H3864_023_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	023	0	1	01	01	H3864_023_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	023	0	1	01	01	H3864_023_0	8	4	Non-Preferred Brand	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	023	0	1	01	01	H3864_023_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	023	0	1	01	01	H3864_023_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	023	0	1	01	01	H3864_023_0	8	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	023	0	1	01	01	H3864_023_0	8	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	024	0	1	02	01	H3864_024_0	10	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	024	0	1	02	01	H3864_024_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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	024	0	1	02	01	H3864_024_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	024	0	1	02	01	H3864_024_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					0.06	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	024	0	1	02	01	H3864_024_0	10	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	024	0	1	02	01	H3864_024_0	10	4	Non-Preferred Brand	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	024	0	1	02	01	H3864_024_0	10	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	024	0	1	02	01	H3864_024_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	024	0	1	02	01	H3864_024_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					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		
H3864	025	0	1	02	01	H3864_025_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					0.06	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	025	0	1	02	01	H3864_025_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	025	0	1	02	01	H3864_025_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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	025	0	1	02	01	H3864_025_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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	025	0	1	02	01	H3864_025_0	7	4	Non-Preferred Brand	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	025	0	1	02	01	H3864_025_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3864	025	0	1	02	01	H3864_025_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					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		
H3864	025	0	1	02	01	H3864_025_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	025	0	1	02	01	H3864_025_0	7	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3887	003	0	1	02	01	H3887_003_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3887	003	0	1	02	01	H3887_003_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																															30.00							20.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3887	003	0	1	02	01	H3887_003_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					707.00	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	2	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							275.00				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	2	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							125.00				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	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	.26	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	2	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		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	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, Select Care Drugs												
H3907	006	0	1	01	01	H3907_006_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					912.00	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	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	7	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	.26	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	7	2	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	7	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	7	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					912.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	7	5	Select Care Drugs	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, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	7	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	.33	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	7	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	7	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					912.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	7	2	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	7	5	Select Care Drugs	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, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	6	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	.33	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	6	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	6	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					912.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	6	2	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	6	5	Select Care Drugs	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, Select Care Drugs												
H3909	001	0	1	04	01	H3909_001_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	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_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	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_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	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	5	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	18.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1114.02	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	4	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	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1114.02	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	4	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	18.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_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	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_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	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1180.34	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	9	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												
H3916	001	0	1	04	01	H3916_001_0	9	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.38	12.00		36.00																								30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	001	0	1	04	01	H3916_001_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.38	12.00		36.00																								30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	002	0	1	04	01	H3916_002_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1180.34	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	9	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												
H3916	002	0	1	04	01	H3916_002_0	9	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.38	12.00		36.00																								30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	002	0	1	04	01	H3916_002_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.38	12.00		36.00																								30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	005	0	1	04	01	H3916_005_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.38	12.00		36.00																								30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	9	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	9	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												
H3916	005	0	1	04	01	H3916_005_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1384.66	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	005	0	1	04	01	H3916_005_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.38	12.00		36.00																								30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	015	0	1	04	01	H3916_015_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.38	12.00		36.00																								30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	10	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_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												
H3916	015	0	1	04	01	H3916_015_0	10	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1155.69	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.38	12.00		36.00																								30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	10	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1333.85	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	10	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	018	0	1	04	01	H3916_018_0	10	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.38	12.00		36.00																								30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	9	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	9	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	022	0	1	04	01	H3916_022_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1135.57	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.38	12.00		36.00																								30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	9	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	9	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	024	0	1	04	01	H3916_024_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1135.57	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	14	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.38	12.00		36.00																								30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	025	0	1	04	01	H3916_025_0	14	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	025	0	1	04	01	H3916_025_0	14	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	025	0	1	04	01	H3916_025_0	14	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1150.79	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	14	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	032	0	1	04	01	H3916_032_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.48	15.00		45.00																								37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	10	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	10	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	032	0	1	04	01	H3916_032_0	10	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1135.57	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	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	9	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	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.48	15.00		45.00																								37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	9	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1135.57	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	001	0	1	04	01	H3921_001_0	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	001	0	1	04	01	H3921_001_0	2	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							125.00				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	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					685.00	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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					509.00	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	2	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							275.00				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	2	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							125.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	008	0	1	04	01	H3921_008_0	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	009	0	1	04	01	H3921_009_0	2	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																															285.00							275.00				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	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	009	0	1	04	01	H3921_009_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	009	0	1	04	01	H3921_009_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					497.00	33		33																														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	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													785.00	33							785.00	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	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		285.00					2.90	90.00		270.00					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	6	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					1.23	38.00		114.00					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	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.32	10.00		30.00					.16	5.00		15.00					.16	5.00		15.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.71	22.00		66.00					.55	17.00		51.00					.55	17.00		51.00																		22.00				.71	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_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		285.00					2.87	89.00		267.00					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	6	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					1.23	38.00		114.00					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	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					.32	10.00		30.00					.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	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.29	9.00		27.00					.13	4.00		12.00					.13	4.00		12.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													741.00	33							741.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	054	0	1	04	01	H3924_054_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	054	0	1	04	01	H3924_054_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			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												
H3924	054	0	1	04	01	H3924_054_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																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	054	0	1	04	01	H3924_054_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3924	054	0	1	04	01	H3924_054_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		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	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	059	3	1	04	01	H3924_059_3	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.60	18.00		54.00																								54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	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																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3924	059	3	1	04	01	H3924_059_3	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	5	1	Preferred Generic	3	4	001000	1	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										1		
H3924	059	4	1	04	01	H3924_059_4	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.60	18.00		54.00																								54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	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																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3924	059	4	1	04	01	H3924_059_4	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	5	1	Preferred Generic	3	4	001000	1	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										1		
H3924	060	3	1	04	01	H3924_060_3	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	3	1	04	01	H3924_060_3	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	3	1	04	01	H3924_060_3	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			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												
H3924	060	3	1	04	01	H3924_060_3	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																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	3	1	04	01	H3924_060_3	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3924	060	3	1	04	01	H3924_060_3	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	4	1	04	01	H3924_060_4	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	4	1	04	01	H3924_060_4	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	4	1	04	01	H3924_060_4	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3924	060	4	1	04	01	H3924_060_4	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																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	4	1	04	01	H3924_060_4	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			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												
H3924	060	4	1	04	01	H3924_060_4	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	061	1	1	04	01	H3924_061_1	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																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	061	1	1	04	01	H3924_061_1	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3924	061	1	1	04	01	H3924_061_1	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	061	1	1	04	01	H3924_061_1	5	1	Preferred Generic	3	4	001000	1	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										1		
H3924	061	1	1	04	01	H3924_061_1	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	061	1	1	04	01	H3924_061_1	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.60	18.00		54.00																								54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	061	2	1	04	01	H3924_061_2	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	061	2	1	04	01	H3924_061_2	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																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	061	2	1	04	01	H3924_061_2	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3924	061	2	1	04	01	H3924_061_2	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	061	2	1	04	01	H3924_061_2	5	1	Preferred Generic	3	4	001000	1	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										1		
H3924	061	2	1	04	01	H3924_061_2	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.60	18.00		54.00																								54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	061	5	1	04	01	H3924_061_5	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	061	5	1	04	01	H3924_061_5	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																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	061	5	1	04	01	H3924_061_5	5	1	Preferred Generic	3	4	001000	1	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										1		
H3924	061	5	1	04	01	H3924_061_5	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	061	5	1	04	01	H3924_061_5	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3924	061	5	1	04	01	H3924_061_5	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.60	18.00		54.00																								54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.40	12.00	24.00	36.00					0.26	8.00	16.00	24.00					0.26	8.00	16.00	24.00																			12.00			0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	7	3	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	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												
H3928	001	0	1	01	01	H3928_001_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													53.54	50	50	50					51.02	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	7	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3928	002	0	1	01	01	H3928_002_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.00	0.00	0.00	0.00					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												
H3928	002	0	1	01	01	H3928_002_0	8	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	8	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													52.82	50	50	50					50.32	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	8	3	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	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												
H3928	002	0	1	01	01	H3928_002_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.66	20.00	40.00	60.00					0.33	10.00	20.00	30.00					0.33	10.00	20.00	30.00																			20.00			0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	8	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.00	0.00	0.00	0.00					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										1		
H3931	004	0	1	01	01	H3931_004_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													44.54	50	50	50					41.79	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	5	3	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	135.00												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												
H3931	004	0	1	01	01	H3931_004_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	15.00					0.00	0.00	0.00	0.00												0.20	6.00	12.00	15.00				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												
H3931	004	0	1	01	01	H3931_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.53	16.00	32.00	40.00					0.33	10.00	20.00	25.00												0.53	16.00	32.00	40.00				0.33	10.00	20.00	25.00					16.00			0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	058	0	1	01	01	H3931_058_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													40.65	50	50	50					40.53	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	058	0	1	01	01	H3931_058_0	4	3	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	135.00												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												
H3931	058	0	1	01	01	H3931_058_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.53	16.00	32.00	40.00					0.33	10.00	20.00	25.00												0.53	16.00	32.00	40.00				0.33	10.00	20.00	25.00					16.00			0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	058	0	1	01	01	H3931_058_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	15.00					0.00	0.00	0.00	0.00												0.20	6.00	12.00	15.00				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												
H3931	058	0	1	01	01	H3931_058_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	064	0	1	01	01	H3931_064_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	15.00					0.00	0.00	0.00	0.00												0.20	6.00	12.00	15.00				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												
H3931	064	0	1	01	01	H3931_064_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.53	16.00	32.00	40.00					0.33	10.00	20.00	25.00												0.53	16.00	32.00	40.00				0.33	10.00	20.00	25.00					16.00			0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	064	0	1	01	01	H3931_064_0	4	3	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	135.00												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												
H3931	064	0	1	01	01	H3931_064_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													45.88	50	50	50					43.15	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	064	0	1	01	01	H3931_064_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	30							1.00	30														30							30						30			30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	065	0	1	01	01	H3931_065_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	18.00					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												
H3931	065	0	1	01	01	H3931_065_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.50	15.00	30.00	45.00					0.30	9.00	18.00	27.00												0.50	15.00	30.00	45.00				0.30	9.00	18.00	27.00					15.00			0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	065	0	1	01	01	H3931_065_0	4	3	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	135.00												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												
H3931	065	0	1	01	01	H3931_065_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													41.18	50	50	50					39.23	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	065	0	1	01	01	H3931_065_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	31							1.00	31														31							31						31			31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.66	20.00	40.00	40.00					0.50	15.00	30.00	30.00												0.66	20.00	40.00	40.00				0.50	15.00	30.00	30.00					20.00			0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00												0.16	5.00	10.00	10.00				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												
H3931	070	0	1	01	01	H3931_070_0	4	3	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	135.00												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												
H3931	070	0	1	01	01	H3931_070_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													41.99	50	50	50					38.95	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													50.20	50	50	50					47.04	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_0	4	3	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	135.00												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												
H3931	081	0	1	01	01	H3931_081_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.43	13.00	26.00	39.00					0.30	9.00	18.00	27.00												0.43	13.00	26.00	39.00				0.30	9.00	18.00	27.00					13.00			0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	082	0	1	01	01	H3931_082_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													48.75	50	50	50					45.67	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	082	0	1	01	01	H3931_082_0	4	3	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	135.00												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												
H3931	082	0	1	01	01	H3931_082_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.43	13.00	26.00	39.00					0.30	9.00	18.00	27.00												0.43	13.00	26.00	39.00				0.30	9.00	18.00	27.00					13.00			0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	082	0	1	01	01	H3931_082_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	082	0	1	01	01	H3931_082_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	083	0	1	01	01	H3931_083_0	3	1	Preferred Generic	1	3	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	083	0	1	01	01	H3931_083_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	18.00					0.06	2.00	4.00	6.00												0.20	6.00	12.00	18.00				0.06	2.00	4.00	6.00					6.00			0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	083	0	1	01	01	H3931_083_0	3	3	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	135.00												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												
H3931	083	0	1	01	01	H3931_083_0	3	4	Non-Preferred Brand	1	3	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													46.15	50	50	50					43.75	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	083	0	1	01	01	H3931_083_0	3	5	Specialty Tier	1	3	010010	1	1		010	10		010	1				30							30				10	31													1.00	26							1.00	26														26							26						26			26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	084	0	1	01	01	H3931_084_0	3	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	15.00					0.00	0.00	0.00	0.00												0.20	6.00	12.00	15.00				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												
H3931	084	0	1	01	01	H3931_084_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.60	18.00	36.00	45.00					0.40	12.00	24.00	30.00												0.60	18.00	36.00	45.00				0.40	12.00	24.00	30.00					18.00			0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	084	0	1	01	01	H3931_084_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													40.53	50	50	50					38.62	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	084	0	1	01	01	H3931_084_0	3	3	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	135.00												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												
H3931	084	0	1	01	01	H3931_084_0	3	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	087	0	1	01	01	H3931_087_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	087	0	1	01	01	H3931_087_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.53	16.00	32.00	48.00					0.40	12.00	24.00	36.00												0.53	16.00	32.00	48.00				0.40	12.00	24.00	36.00					16.00			0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	087	0	1	01	01	H3931_087_0	4	3	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	135.00												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												
H3931	087	0	1	01	01	H3931_087_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													47.33	50	50	50					44.39	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	087	0	1	01	01	H3931_087_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	088	0	1	01	01	H3931_088_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	17.50					0.10	3.00	6.00	7.50												0.23	7.00	14.00	17.50				0.10	3.00	6.00	7.50					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	088	0	1	01	01	H3931_088_0	7	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	10.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	088	0	1	01	01	H3931_088_0	7	3	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	112.50					1.50	45.00	90.00	112.50												1.50	45.00	90.00	112.50				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												
H3931	088	0	1	01	01	H3931_088_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													38.93	50	50	50					36.68	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	088	0	1	01	01	H3931_088_0	7	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	088	0	1	01	01	H3931_088_0	7	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	10.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3931	090	0	1	01	01	H3931_090_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.46	14.00	28.00	42.00					.33	10.00	20.00	30.00												.46	14.00	28.00	42.00				.33	10.00	20.00	30.00					14.00			.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	090	0	1	01	01	H3931_090_0	3	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	090	0	1	01	01	H3931_090_0	3	3	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	135.00												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												
H3931	090	0	1	01	01	H3931_090_0	3	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3931	090	0	1	01	01	H3931_090_0	3	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	090	0	1	01	01	H3931_090_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.25	50	50	50					35.07	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	15.00					0.00	0.00	0.00	0.00												0.20	6.00	12.00	15.00				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												
H3931	091	0	1	01	01	H3931_091_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													58.98	50	50	50					56.25	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	4	3	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	135.00												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												
H3931	091	0	1	01	01	H3931_091_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.66	20.00	40.00	50.00					0.46	14.00	28.00	35.00												0.66	20.00	40.00	50.00				0.46	14.00	28.00	35.00					20.00			0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	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	6	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		15.00																		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	6	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		15.00																		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	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	6	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		225.00																		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	6	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					635.36	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	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		24.00																		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	5	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		12.00																		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	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		120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					599.43	28	28	28																					28		28																	28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_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		240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	024	0	1	01	01	H3949_024_0	5	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		12.00																		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	5	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		30.00																		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	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					504.05	26	26	26																					26		26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00		270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	5	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		15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	027	0	1	02	01	H3949_027_0	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		21.00																		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	5	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		30.00																		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	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					620.01	26	26	26																					26		26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	027	0	1	02	01	H3949_027_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		240.00																		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	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		120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	028	0	1	01	01	H3949_028_0	5	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		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	028	0	1	01	01	H3949_028_0	5	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		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	028	0	1	01	01	H3949_028_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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	028	0	1	01	01	H3949_028_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00		270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	028	0	1	01	01	H3949_028_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					626.19	26	26	26																					26		26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	029	1	1	01	01	H3949_029_1	5	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		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	029	1	1	01	01	H3949_029_1	5	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		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	029	1	1	01	01	H3949_029_1	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	029	1	1	01	01	H3949_029_1	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					626.19	26	26	26																					26		26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	029	1	1	01	01	H3949_029_1	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00		270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	029	2	1	01	01	H3949_029_2	6	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		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	029	2	1	01	01	H3949_029_2	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00		270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	029	2	1	01	01	H3949_029_2	6	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		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	029	2	1	01	01	H3949_029_2	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	029	2	1	01	01	H3949_029_2	6	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					626.19	26	26	26																					26		26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	6	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	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1531.52	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	6	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												
H3952	020	0	1	01	01	H3952_020_0	6	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												
H3952	020	0	1	01	01	H3952_020_0	6	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												
H3952	045	0	1	01	01	H3952_045_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1462.73	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_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	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_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	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	5	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												
H3952	045	0	1	01	01	H3952_045_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	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	6	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	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	6	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	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	6	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												
H3952	049	0	1	01	01	H3952_049_0	6	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												
H3952	049	0	1	01	01	H3952_049_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1429.65	25	25	25																					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	4	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	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_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	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_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	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	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	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1234.50	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	052	0	1	01	01	H3952_052_0	4	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	15.00																					.16	5.00	10.00	10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	052	0	1	01	01	H3952_052_0	4	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												
H3952	052	0	1	01	01	H3952_052_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1496.27	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	052	0	1	01	01	H3952_052_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	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	052	0	1	01	01	H3952_052_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	90.00																		45.00				1.45	45.00		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	30		90				2			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												
H3954	146	0	1	01	01	H3954_146_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		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	30		90				2			90				30		31	1.30	39.00		117.00																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	146	0	1	01	01	H3954_146_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3954	146	0	1	01	01	H3954_146_0	6	5	Specialty Tier	1	4	000010	1	1	010		01			1	30													30		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	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	1	1	01	01	H3954_157_1	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	1	1	01	01	H3954_157_1	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.60	18.00		54.00																								54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	1	1	01	01	H3954_157_1	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.30	39.00		117.00																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	1	1	01	01	H3954_157_1	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3954	157	1	1	01	01	H3954_157_1	4	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	1	1	01	01	H3954_157_1	4	1	Preferred Generic	3	4	001000	1	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										1		
H3954	157	2	1	01	01	H3954_157_2	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.60	18.00		54.00																								54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	2	1	01	01	H3954_157_2	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3954	157	2	1	01	01	H3954_157_2	4	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	2	1	01	01	H3954_157_2	4	1	Preferred Generic	3	4	001000	1	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										1		
H3954	157	2	1	01	01	H3954_157_2	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.30	39.00		117.00																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	2	1	01	01	H3954_157_2	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.30	39.00		117.00																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3954	157	3	1	01	01	H3954_157_3	4	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	4	1	Preferred Generic	3	4	001000	1	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										1		
H3954	157	3	1	01	01	H3954_157_3	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.60	18.00		54.00																								54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	4	1	01	01	H3954_157_4	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.60	18.00		54.00																								54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	4	1	01	01	H3954_157_4	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	4	1	01	01	H3954_157_4	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3954	157	4	1	01	01	H3954_157_4	4	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	4	1	01	01	H3954_157_4	4	1	Preferred Generic	3	4	001000	1	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										1		
H3954	157	4	1	01	01	H3954_157_4	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.30	39.00		117.00																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.60	18.00		54.00																								54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.30	39.00		117.00																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3954	157	5	1	01	01	H3954_157_5	4	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	4	1	Preferred Generic	3	4	001000	1	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										1		
H3954	157	5	1	01	01	H3954_157_5	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	1	1	01	01	H3954_158_1	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3954	158	1	1	01	01	H3954_158_1	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			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												
H3954	158	1	1	01	01	H3954_158_1	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																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	2	1	01	01	H3954_158_2	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3954	158	2	1	01	01	H3954_158_2	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	2	1	01	01	H3954_158_2	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																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	2	1	01	01	H3954_158_2	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			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												
H3954	158	2	1	01	01	H3954_158_2	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	2	1	01	01	H3954_158_2	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	3	1	01	01	H3954_158_3	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			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												
H3954	158	3	1	01	01	H3954_158_3	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	3	1	01	01	H3954_158_3	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																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	3	1	01	01	H3954_158_3	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	3	1	01	01	H3954_158_3	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	3	1	01	01	H3954_158_3	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3954	158	4	1	01	01	H3954_158_4	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	4	1	01	01	H3954_158_4	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			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												
H3954	158	4	1	01	01	H3954_158_4	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	4	1	01	01	H3954_158_4	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3954	158	4	1	01	01	H3954_158_4	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																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	4	1	01	01	H3954_158_4	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	5	1	01	01	H3954_158_5	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	5	1	01	01	H3954_158_5	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.20	6.00		18.00																								18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			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												
H3954	158	5	1	01	01	H3954_158_5	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																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H3957	003	0	1	01	01	H3957_003_0	8	1	Preferred Generic	1	4	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												
H3957	003	0	1	01	01	H3957_003_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.38	12.00		36.00																								30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	8	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	8	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												
H3957	003	0	1	01	01	H3957_003_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1214.11	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	8	1	Preferred Generic	1	4	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												
H3957	006	0	1	01	01	H3957_006_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.38	12.00		36.00																								30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	8	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	8	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												
H3957	006	0	1	01	01	H3957_006_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1171.68	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1164.83	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	7	1	Preferred Generic	3	4	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										1		
H3957	020	0	1	01	01	H3957_020_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.38	12.00		36.00																								30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3957	020	0	1	01	01	H3957_020_0	7	1	Preferred Generic	1	4	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												
H3957	020	0	1	01	01	H3957_020_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.38	12.00		36.00																								30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	7	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	7	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												
H3957	021	0	1	01	01	H3957_021_0	7	1	Preferred Generic	1	4	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												
H3957	021	0	1	01	01	H3957_021_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.38	12.00		36.00																								30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	7	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	7	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												
H3957	021	0	1	01	01	H3957_021_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.38	12.00		36.00																								30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3957	021	0	1	01	01	H3957_021_0	7	1	Preferred Generic	3	4	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										1		
H3957	021	0	1	01	01	H3957_021_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1195.70	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1170.84	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	8	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	031	0	1	01	01	H3957_031_0	8	1	Preferred Generic	1	4	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												
H3957	031	0	1	01	01	H3957_031_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.38	12.00		36.00																								30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	8	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					974.63	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	8	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	032	0	1	01	01	H3957_032_0	8	1	Preferred Generic	1	4	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												
H3957	032	0	1	01	01	H3957_032_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.38	12.00		36.00																								30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	8	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_0	8	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_0	8	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	038	0	1	01	01	H3957_038_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1196.50	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_0	8	1	Preferred Generic	1	4	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												
H3957	038	0	1	01	01	H3957_038_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.48	15.00		45.00																								37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	.09	3.00		9.00																								7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	10	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1191.09	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_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												
H3957	039	0	1	01	01	H3957_039_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												
H3957	039	0	1	01	01	H3957_039_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.38	12.00		36.00																								30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.38	12.00		36.00																								30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3957	039	0	1	01	01	H3957_039_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	.09	3.00		9.00																								7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3959	001	0	1	01	01	H3959_001_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	25.00					0.16	5.00	10.00	12.50					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												
H3959	001	0	1	01	01	H3959_001_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.56	17.00	34.00	42.50					0.23	7.00	14.00	17.50					0.23	7.00	14.00	17.50																			17.00			0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.56	17.00	34.00	42.50					0.23	7.00	14.00	17.50					0.23	7.00	14.00	17.50																			17.00			0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3959	001	0	1	01	01	H3959_001_0	3	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	25.00					0.16	5.00	10.00	12.50					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		
H3959	001	0	1	01	01	H3959_001_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	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	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													57.82	50	50	50					55.04	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	3	3	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	112.50					1.50	45.00	90.00	112.50					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												
H3959	002	0	1	01	01	H3959_002_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	4	2	Non-Preferred Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.66	20.00	40.00	50.00					0.33	10.00	20.00	25.00					0.33	10.00	20.00	25.00																			20.00			0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3959	002	0	1	01	01	H3959_002_0	4	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	25.00					0.16	5.00	10.00	12.50					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		
H3959	002	0	1	01	01	H3959_002_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													60.98	50	50	50					58.18	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	4	3	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	112.50					1.50	45.00	90.00	112.50					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												
H3959	002	0	1	01	01	H3959_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.66	20.00	40.00	50.00					0.33	10.00	20.00	25.00					0.33	10.00	20.00	25.00																			20.00			0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	25.00					0.16	5.00	10.00	12.50					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												
H3959	010	0	1	01	01	H3959_010_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	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												
H3959	010	0	1	01	01	H3959_010_0	3	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.23	7.00	14.00	21.00																					0.23	7.00	14.00	21.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	3	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					57.24	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	3	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	3	3	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	135.00																			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	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													64.23	50	50	50					60.07	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	3	3	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	112.50					1.50	45.00	90.00	112.50					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												
H3959	011	0	1	01	01	H3959_011_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.73	22.00	44.00	55.00					0.40	12.00	24.00	30.00					0.40	12.00	24.00	30.00																			22.00			0.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	25.00					0.23	7.00	14.00	17.50					0.23	7.00	14.00	17.50																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	031	0	1	01	01	H3959_031_0	3	3	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	135.00																			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	3	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	031	0	1	01	01	H3959_031_0	3	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					59.56	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	031	0	1	01	01	H3959_031_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.50	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												
H3959	031	0	1	01	01	H3959_031_0	3	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.23	7.00	14.00	21.00																					0.23	7.00	14.00	21.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.66	20.00	40.00	50.00					0.33	10.00	20.00	25.00					0.33	10.00	20.00	25.00																			20.00			0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	4	3	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	112.50					1.50	45.00	90.00	112.50					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												
H3959	032	0	1	01	01	H3959_032_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													59.34	50	50	50					55.98	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	25.00					0.23	7.00	14.00	17.50					0.23	7.00	14.00	17.50																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	3	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	3	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					58.09	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.50	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												
H3959	033	0	1	01	01	H3959_033_0	3	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.23	7.00	14.00	21.00																					0.23	7.00	14.00	21.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	3	3	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	135.00																			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	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													57.55	50	50	50					56.29	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	3	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.20	6.00	12.00	18.00					0.20	6.00	12.00	18.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3959	037	0	1	01	01	H3959_037_0	3	3	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	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												
H3959	037	0	1	01	01	H3959_037_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.63	19.00	38.00	57.00					0.30	9.00	18.00	27.00					0.30	9.00	18.00	27.00																			19.00			0.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.20	6.00	12.00	18.00					0.20	6.00	12.00	18.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	038	0	1	01	01	H3959_038_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.63	19.00	38.00	57.00																					0.63	19.00	38.00	57.00																			19.00			0.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	038	0	1	01	01	H3959_038_0	2	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	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												
H3959	038	0	1	01	01	H3959_038_0	2	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	038	0	1	01	01	H3959_038_0	2	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					56.56	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	038	0	1	01	01	H3959_038_0	2	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	039	0	1	01	01	H3959_039_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	039	0	1	01	01	H3959_039_0	3	3	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	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												
H3959	039	0	1	01	01	H3959_039_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.06	32.00	64.00	96.00					0.73	22.00	44.00	66.00					0.73	22.00	44.00	66.00																			32.00			1.03	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	039	0	1	01	01	H3959_039_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													62.82	50	50	50					61.84	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	039	0	1	01	01	H3959_039_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	12.00																			10.00			0.32	10.00		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									.26	8.00		24.00					.10	3.00		9.00					.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									.45	14.00		42.00					.29	9.00		27.00					.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									1.45	45.00		135.00					1.23	38.00		114.00					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									3.06	95.00		285.00					2.87	89.00		267.00					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													723.00	33							723.00	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									.26	8.00		24.00					.10	3.00		9.00					.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									.45	14.00		42.00					.29	9.00		27.00					.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									.29	9.00		27.00					.13	4.00		12.00					.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	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					.39	12.00		36.00					.39	12.00		36.00																		17.00				.55	17.00		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													625.00	33							625.00	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									3.06	95.00		285.00					2.87	89.00		267.00					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									1.45	45.00		135.00					1.23	38.00		114.00					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	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									.32	10.00		30.00					.13	4.00		12.00					.13	4.00		12.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	007	0	1	01	01	H3962_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		285.00					2.87	89.00		267.00					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	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									1.45	45.00		135.00					1.23	38.00		114.00					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	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									.65	20.00		60.00					.39	12.00		36.00					.39	12.00		36.00																		20.00				.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													465.00	33							465.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_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					0.00	0.00		0.00								15.00																		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	8	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	8	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	8	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3979	001	0	1	01	01	H3979_001_0	8	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3979	002	0	1	02	01	H3979_002_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					0.00	0.00		0.00								15.00																		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	7	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	7	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	7	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3979	002	0	1	02	01	H3979_002_0	7	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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 Care 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	.23	7.00		21.00																								14.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier, Select Care 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 Care 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 Care Drugs												
H4003	009	0	1	01	01	H4003_009_0	8	5	Select Care 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 Care Drugs												
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 Care Drugs										2		
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	.23	7.00		21.00																								14.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	015	0	1	01	01	H4003_015_0	8	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												
H4003	015	0	1	01	01	H4003_015_0	8	2	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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	015	0	1	01	01	H4003_015_0	8	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	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	015	0	1	01	01	H4003_015_0	8	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		
H4003	019	0	1	01	01	H4003_019_0	8	3	Non-Preferred Brand	1	4	100000	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	019	0	1	01	01	H4003_019_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	019	0	1	01	01	H4003_019_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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_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	019	0	1	01	01	H4003_019_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, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	027	0	1	02	01	H4003_027_0	9	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.80	24.00		72.00																								48.00																		24.00				.77	24.00		Preferred Generic, Preferred Brand, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_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				.12	4.00		Preferred Generic, Preferred Brand, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_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												
H4003	027	0	1	02	01	H4003_027_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				.12	4.00		Preferred Generic, Preferred Brand, Specialty Tier										2		
H4003	029	0	1	02	01	H4003_029_0	9	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	029	0	1	02	01	H4003_029_0	9	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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	029	0	1	02	01	H4003_029_0	9	3	Non-Preferred Brand	1	4	100000	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	029	0	1	02	01	H4003_029_0	9	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, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	029	0	1	02	01	H4003_029_0	9	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	031	0	1	02	01	H4003_031_0	9	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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	031	0	1	02	01	H4003_031_0	9	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	031	0	1	02	01	H4003_031_0	9	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	031	0	1	02	01	H4003_031_0	9	3	Non-Preferred Brand	1	4	100000	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	031	0	1	02	01	H4003_031_0	9	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, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4004	015	0	1	02	01	H4004_015_0	9	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	9	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, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4004	015	0	1	02	01	H4004_015_0	9	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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	015	0	1	02	01	H4004_015_0	9	2	Preferred Brand	1	4	000001	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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	015	0	1	02	01	H4004_015_0	9	3	Non-Preferred Brand	1	4	100000	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, Non-Preferred Brand, Specialty Tier												
H4004	050	0	1	01	01	H4004_050_0	9	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, Specialty Tier										2		
H4004	050	0	1	01	01	H4004_050_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	050	0	1	01	01	H4004_050_0	9	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	9	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, Specialty Tier												
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	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Specialty Tier												
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	.83	25.00		75.00																								50.00																		25.00				.80	25.00		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	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Specialty Tier										2		
H4005	004	0	1	04	01	H4005_004_0	10	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31													33.00	33		33					25.00	25		25							25																	33				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	10	4	Non-Preferred Brand	1	4	100000	3	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					1.33	40.00		120.00								80.00																		95.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	10	3	Preferred Brand	1	4	000001	3	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		135.00					.83	25.00		75.00								50.00																		45.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	10	2	Non-Preferred Generic	1	4	000100	3	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					.33	10.00		30.00								20.00																		33.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	10	1	Preferred Generic	1	4	001000	3	2		110	01	100		1				30		90	1			90				30		31									0.33	10.00		30.00					0.16	5.00		15.00								10.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	10	1	Preferred Generic	3	4	001000	3	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.16	5.00		15.00								10.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H4005	004	0	1	04	01	H4005_004_0	10	2	Non-Preferred Generic	3	4	000100	3	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					.33	10.00		30.00								20.00																		33.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H4007	005	0	1	01	01	H4007_005_0	8	3	Non-Preferred Brand	1	3	100100	1	1	110		01	110		1	30		90				2	30		90				30		31					28.00	25		25																					25		25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	005	0	1	01	01	H4007_005_0	8	2	Preferred Brand	1	3	010001	1	1	110		01	110		1	30		90				2	30		90				30		31					56.00	25		25																					25		25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	005	0	1	01	01	H4007_005_0	8	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, Specialty Tier												
H4007	005	0	1	01	01	H4007_005_0	8	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31						25																							25																			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_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	
H4007	012	0	1	01	01	H4007_012_0	6	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		45.00				0.50	15.00		35.00				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	6	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		90.00				1.00	30.00		80.00				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	6	4	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						25																														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	6	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		90.00				1.00	30.00		80.00				30.00				0.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	6	4	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						25																														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	012	0	1	01	01	H4007_012_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												
H4007	012	0	1	01	01	H4007_012_0	6	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		45.00				0.50	15.00		35.00				15.00				0.48	15.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	013	0	1	01	01	H4007_013_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, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	013	0	1	01	01	H4007_013_0	7	2	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												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												
H4007	013	0	1	01	01	H4007_013_0	7	4	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	013	0	1	01	01	H4007_013_0	7	3	Non-Preferred Brand	3	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	0.96	29.00		87.00																												0.96	29.00		87.00				0.96	29.00		77.00				29.00				0.93	29.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	013	0	1	01	01	H4007_013_0	7	2	Preferred Brand	3	4	010001	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												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										2	3	
H4007	013	0	1	01	01	H4007_013_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, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	013	0	1	01	01	H4007_013_0	7	4	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	013	0	1	01	01	H4007_013_0	7	3	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	0.96	29.00		87.00																												0.96	29.00		87.00				0.96	29.00		77.00				29.00				0.93	29.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	016	0	1	01	01	H4007_016_0	4	2	Preferred Brand	1	3	010001	1	1	110		01	110		1	30		90				2	30		90				30		31					54.00	25		25																					25		25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	016	0	1	01	01	H4007_016_0	4	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, Specialty Tier												
H4007	016	0	1	01	01	H4007_016_0	4	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31						25																							25																			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	016	0	1	01	01	H4007_016_0	4	3	Non-Preferred Brand	1	3	100100	1	1	110		01	110		1	30		90				2	30		90				30		31					26.00	25		25																					25		25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4011	003	0	1	04	01	H4011_003_0	11	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												
H4011	003	0	1	04	01	H4011_003_0	11	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	11	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												
H4011	003	0	1	04	01	H4011_003_0	11	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												
H4011	003	0	1	04	01	H4011_003_0	11	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.47	14.00		42.00																								28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4011	003	0	1	04	01	H4011_003_0	11	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												
H4011	003	0	1	04	01	H4011_003_0	11	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.47	14.00		42.00																								28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4036	008	0	1	04	01	H4036_008_0	12	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	12	6	Select Care Drugs	1	3	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												
H4036	008	0	1	04	01	H4036_008_0	12	5	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, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	12	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.86	26.00	52.00	78.00					0.70	21.00	42.00	63.00					0.70	21.00	42.00	42.00																		26.00				0.76	26.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	12	5	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, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	12	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	8.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	12	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.66	20.00	40.00	60.00					0.50	15.00	30.00	45.00					0.50	15.00	30.00	30.00																		20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	12	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					1.16	35.00	70.00	105.00					1.16	35.00	105.00	105.00																		40.00				1.17	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	12	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					2.83	85.00	170.00	255.00					2.83	85.00	255.00	255.00																		90.00				2.64	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	12	6	Select Care Drugs	1	3	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												
H4102	001	0	1	01	01	H4102_001_0	2	5	Specialty Tier	1	3	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												
H4102	001	0	1	01	01	H4102_001_0	2	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							275.00				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	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	001	0	1	01	01	H4102_001_0	2	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																															27.00							18.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	001	0	1	01	01	H4102_001_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	030	0	1	01	01	H4102_030_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	030	0	1	01	01	H4102_030_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					509.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	030	0	1	01	01	H4102_030_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	030	0	1	01	01	H4102_030_0	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	030	0	1	01	01	H4102_030_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	031	0	1	01	01	H4102_031_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					652.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	031	0	1	01	01	H4102_031_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	031	0	1	01	01	H4102_031_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	031	0	1	01	01	H4102_031_0	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	031	0	1	01	01	H4102_031_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	032	0	1	01	01	H4102_032_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	032	0	1	01	01	H4102_032_0	2	5	Specialty Tier	1	3	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												
H4102	032	0	1	01	01	H4102_032_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	032	0	1	01	01	H4102_032_0	2	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																															27.00							18.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	032	0	1	01	01	H4102_032_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	033	0	1	01	01	H4102_033_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															9.00							6.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	033	0	1	01	01	H4102_033_0	2	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																															27.00							18.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	033	0	1	01	01	H4102_033_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	033	0	1	01	01	H4102_033_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	033	0	1	01	01	H4102_033_0	2	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												
H4141	001	0	1	01	01	H4141_001_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												
H4141	001	0	1	01	01	H4141_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	001	0	1	01	01	H4141_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		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										2	3	
H4141	001	0	1	01	01	H4141_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		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										2	3	
H4141	001	0	1	01	01	H4141_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	001	0	1	01	01	H4141_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		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												
H4141	001	0	1	01	01	H4141_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		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												
H4141	001	0	1	01	01	H4141_001_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_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	
H4141	003	0	1	01	01	H4141_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		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												
H4141	003	0	1	01	01	H4141_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		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												
H4141	003	0	1	01	01	H4141_003_0	5	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	003	0	1	01	01	H4141_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												
H4141	003	0	1	01	01	H4141_003_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	004	0	1	01	01	H4141_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	004	0	1	01	01	H4141_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	004	0	1	01	01	H4141_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		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										2	3	
H4141	004	0	1	01	01	H4141_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		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										2	3	
H4141	004	0	1	01	01	H4141_004_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	004	0	1	01	01	H4141_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		18.00				0.20	6.00		0.00				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	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		54.00				0.60	18.00		0.00				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	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		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												
H4141	004	0	1	01	01	H4141_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		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												
H4141	004	0	1	01	01	H4141_004_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_008_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		15.00				0.16	5.00		0.00				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	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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_008_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	008	0	1	01	01	H4141_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		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										2	3	
H4141	008	0	1	01	01	H4141_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		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										2	3	
H4141	008	0	1	01	01	H4141_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	008	0	1	01	01	H4141_008_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	008	0	1	01	01	H4141_008_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_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		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												
H4141	008	0	1	01	01	H4141_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		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												
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						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4141	009	0	1	01	01	H4141_009_0	5	6	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				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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		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, Select Care Drugs												
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		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 Care Drugs												
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	0.50	15.00		45.00																												0.50	15.00		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	0.50	15.00		45.00																												0.50	15.00		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
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		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, Select Care Drugs										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						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										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, Select Care Drugs												
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, Select Care Drugs										2	3	
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		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 Care Drugs										2	3	
H4141	010	0	1	01	01	H4141_010_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	010	0	1	01	01	H4141_010_0	8	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H4141	010	0	1	01	01	H4141_010_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		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												
H4141	010	0	1	01	01	H4141_010_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												
H4141	011	0	1	01	01	H4141_011_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		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												
H4141	011	0	1	01	01	H4141_011_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		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												
H4141	011	0	1	01	01	H4141_011_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						27																														27							27					27				27	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	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		18.00				0.20	6.00		0.00				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	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4145	001	0	1	01	01	H4145_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		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												
H4145	001	0	1	01	01	H4145_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		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												
H4145	001	0	1	01	01	H4145_001_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4145	001	0	1	01	01	H4145_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4145	001	0	1	01	01	H4145_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		30.00				0.33	10.00		0.00				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	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		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										2	3	
H4145	001	0	1	01	01	H4145_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		30.00				0.33	10.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				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	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		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										2	3	
H4145	002	0	1	01	01	H4145_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		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										2	3	
H4145	002	0	1	01	01	H4145_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		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										2	3	
H4145	002	0	1	01	01	H4145_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		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												
H4145	002	0	1	01	01	H4145_002_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4145	002	0	1	01	01	H4145_002_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4145	002	0	1	01	01	H4145_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4145	002	0	1	01	01	H4145_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4145	002	0	1	01	01	H4145_002_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4145	002	0	1	01	01	H4145_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		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												
H4145	002	0	1	01	01	H4145_002_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	11	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	11	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	.10	3.00	6.00	9.00																								6.00																		3.00				.10	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	11	3	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	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	11	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	11	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	11	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	.10	3.00	6.00	9.00																								6.00																		3.00				.10	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	11	3	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	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	11	1	Generic	3	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	.10	3.00	6.00	9.00																								6.00																		3.00				.10	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4152	007	0	1	02	01	H4152_007_0	11	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	013	0	1	01	01	H4152_013_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																								14.00																		7.00				0.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	10	3	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	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	10	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	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						28																							28																			28				28	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	10	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.07	2.00	4.00	6.00																								4.00																		2.00				0.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	10	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	10	3	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	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	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						25																							25																			25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	9	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	017	0	1	01	01	H4152_017_0	9	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	017	0	1	01	01	H4152_017_0	9	3	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	95.00	190.00	285.00																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						28																							28																			28				28	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	10	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				.13	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	10	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	018	0	1	02	01	H4152_018_0	10	3	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	95.00	190.00	285.00																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	10	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												
H4199	001	0	1	01	01	H4199_001_0	6	3	Non-Preferred Brand	1	4	100000	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	001	0	1	01	01	H4199_001_0	6	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31						33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	001	0	1	01	01	H4199_001_0	6	2	Preferred Brand	1	4	000001	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	001	0	1	01	01	H4199_001_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	001	0	1	01	01	H4199_001_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		3
H4199	002	0	1	01	01	H4199_002_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	002	0	1	01	01	H4199_002_0	7	2	Preferred Brand	1	4	000001	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	002	0	1	01	01	H4199_002_0	7	3	Non-Preferred Brand	1	4	100000	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												
H4199	002	0	1	01	01	H4199_002_0	7	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	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		3
H4199	005	0	1	01	01	H4199_005_0	6	2	Preferred Brand	1	4	000001	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	005	0	1	01	01	H4199_005_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	005	0	1	01	01	H4199_005_0	6	3	Non-Preferred Brand	1	4	100000	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	005	0	1	01	01	H4199_005_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		3
H4199	005	0	1	01	01	H4199_005_0	6	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		3
H4199	007	0	1	01	01	H4199_007_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	007	0	1	01	01	H4199_007_0	6	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	1.00	30.00		90.00																								90.00																		30.00				0.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	007	0	1	01	01	H4199_007_0	6	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	6	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	2.67	80.00		240.00																								240.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	007	0	1	01	01	H4199_007_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		3
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	3	Non-Preferred Brand	1	4	100000	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												
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	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	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		3
H4199	010	0	1	01	01	H4199_010_0	7	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	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	2.67	80.00		240.00																								240.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	010	0	1	01	01	H4199_010_0	7	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	1.00	30.00		90.00																								90.00																		30.00				0.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	010	0	1	01	01	H4199_010_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	010	0	1	01	01	H4199_010_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		3
H4199	011	0	1	01	01	H4199_011_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	011	0	1	01	01	H4199_011_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	011	0	1	01	01	H4199_011_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	011	0	1	01	01	H4199_011_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	011	0	1	01	01	H4199_011_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		3
H4199	012	0	1	01	01	H4199_012_0	6	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	6	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.67	50.00		150.00																								150.00																		50.00				1.61	50.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	012	0	1	01	01	H4199_012_0	6	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	0.67	20.00		60.00																								60.00																		20.00				0.65	20.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	012	0	1	01	01	H4199_012_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	012	0	1	01	01	H4199_012_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		3
H4199	013	0	1	01	01	H4199_013_0	6	2	Preferred Brand	1	4	000001	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	013	0	1	01	01	H4199_013_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	013	0	1	01	01	H4199_013_0	6	3	Non-Preferred Brand	1	4	100000	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												
H4199	013	0	1	01	01	H4199_013_0	6	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	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		3
H4199	015	0	1	01	01	H4199_015_0	7	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	0.67	20.00		60.00																								60.00																		20.00				0.65	20.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	015	0	1	01	01	H4199_015_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	015	0	1	01	01	H4199_015_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.67	50.00		150.00																								150.00																		50.00				1.61	50.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	015	0	1	01	01	H4199_015_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		3
H4199	015	0	1	01	01	H4199_015_0	7	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	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	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	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	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	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		3
H4199	017	0	1	01	01	H4199_017_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		3
H4199	017	0	1	01	01	H4199_017_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	017	0	1	01	01	H4199_017_0	6	2	Preferred Brand	1	4	000001	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	017	0	1	01	01	H4199_017_0	6	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	2.17	65.00		195.00																								195.00																		65.00				2.10	65.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	017	0	1	01	01	H4199_017_0	6	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	018	0	1	01	01	H4199_018_0	6	2	Preferred Brand	1	4	000001	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	018	0	1	01	01	H4199_018_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	018	0	1	01	01	H4199_018_0	6	3	Non-Preferred Brand	1	4	100000	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												
H4199	018	0	1	01	01	H4199_018_0	6	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	018	0	1	01	01	H4199_018_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		3
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	0.83	25.00		75.00																								75.00																		25.00				0.81	25.00		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	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	2.17	65.00		195.00																								195.00																		65.00				2.10	65.00		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		3
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	021	0	1	01	01	H4199_021_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	021	0	1	01	01	H4199_021_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	021	0	1	01	01	H4199_021_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	021	0	1	01	01	H4199_021_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	021	0	1	01	01	H4199_021_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		3
H4211	001	0	1	01	01	H4211_001_0	12	2	Non-Preferred Generic	1	4	000100	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												
H4211	001	0	1	01	01	H4211_001_0	12	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	135.00					1.50	45.00	135.00	135.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4211	001	0	1	01	01	H4211_001_0	12	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												
H4211	001	0	1	01	01	H4211_001_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4211	001	0	1	01	01	H4211_001_0	12	5	Specialty Tier	1	4	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, Specialty Tier, Select Care Drugs												
H4211	001	0	1	01	01	H4211_001_0	12	6	Select Care Drugs	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												
H4211	001	0	1	01	01	H4211_001_0	12	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		
H4211	001	0	1	01	01	H4211_001_0	12	2	Non-Preferred Generic	3	4	000100	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		
H4211	001	0	1	01	01	H4211_001_0	12	6	Select Care Drugs	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		
H4211	003	0	1	01	01	H4211_003_0	12	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					0.20	6.00	12.00	18.00					0.20	6.00	12.00	12.00																		11.00				0.32	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4211	003	0	1	01	01	H4211_003_0	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4211	003	0	1	01	01	H4211_003_0	12	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					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4211	003	0	1	01	01	H4211_003_0	12	6	Select Care Drugs	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		
H4211	003	0	1	01	01	H4211_003_0	12	1	Preferred Generic	3	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					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4211	003	0	1	01	01	H4211_003_0	12	6	Select Care Drugs	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												
H4211	003	0	1	01	01	H4211_003_0	12	5	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, Specialty Tier, Select Care Drugs												
H4211	003	0	1	01	01	H4211_003_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4213	004	0	1	09	04	H4213_004_0	15	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					.46	14.00		28.00					.46	14.00		28.00																		33.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	004	0	1	09	04	H4213_004_0	15	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					1.33	40.00		80.00					1.33	40.00		80.00																		45.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	004	0	1	09	04	H4213_004_0	15	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		20.00					.10	3.00		6.00					.10	3.00		6.00																		10.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	004	0	1	09	04	H4213_004_0	15	4	Non-Preferred Brand	1	4	110000	1	1		110	01	110		1				30		90	1	30		90				30		31													32.02	33		33					29.29	30		30					30		30																	33				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	004	0	1	09	04	H4213_004_0	15	5	Specialty Tier	1	4	010010	1	1		110	01	110		1				30		90	1	30		90				30		31													504.78	25		25					311.45	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	13	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									1.10	33.00		82.50					.46	14.00		35.00					.46	14.00		35.00																		33.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	005	0	1	09	04	H4213_005_0	13	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		25.00					.10	3.00		7.50					.10	3.00		7.50																		10.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	005	0	1	09	04	H4213_005_0	13	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		112.50					1.33	40.00		100.00					1.33	40.00		100.00																		45.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	005	0	1	09	04	H4213_005_0	13	4	Non-Preferred Brand	1	3	110000	1	1		110	01	110		1				30		90	1	30		90				30		31													29.18	33		33					30.18	30		30					30		30																	33				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	005	0	1	09	04	H4213_005_0	13	5	Specialty Tier	1	3	010010	1	1		110	01	110		1				30		90	1	30		90				30		31													570.36	25		25					379.60	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	9	5	Specialty Tier	1	2	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												
H4227	001	0	1	01	01	H4227_001_0	9	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	95.00	190.00	285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	9	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	9	3	Preferred Brand	1	2	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												
H4227	001	0	1	01	01	H4227_001_0	9	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								10.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	002	0	1	01	01	H4227_002_0	9	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	95.00	190.00	285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	002	0	1	01	01	H4227_002_0	9	5	Specialty Tier	1	2	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												
H4227	002	0	1	01	01	H4227_002_0	9	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	002	0	1	01	01	H4227_002_0	9	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								10.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	002	0	1	01	01	H4227_002_0	9	3	Preferred Brand	1	2	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												
H4270	006	0	1	02	01	H4270_006_0	6	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				2			90					29	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												
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				2			90					29	31	.93	28.00		84.00																								56.00																			28.00			.90	28.00		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				2			90					29	31					1801.79	31		31																							31																		31			31	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				2			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				2			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												
H4279	001	0	1	01	01	H4279_001_0	10	4	Specialty Tier	1	2	010010	1	1	010		01			1	30													30		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	10	3	Non-Preferred Brand	1	2	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.67	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	10	5	Select Care Drugs	1	2	010000	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	10	2	Preferred Brand	1	2	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.17	35.00		105.00																								105.00																		35.00				1.12	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	10	1	Generic	1	2	010000	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H4346	001	0	1	01	01	H4346_001_0	6	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H4346	001	0	1	01	01	H4346_001_0	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	6	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					2.74	85.00		255.00								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	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H4346	005	0	1	01	01	H4346_005_0	6	6	Select Care Drugs	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																		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	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H4346	005	0	1	01	01	H4346_005_0	6	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					2.74	85.00		255.00								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	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H4346	006	0	1	01	01	H4346_006_0	6	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H4346	006	0	1	01	01	H4346_006_0	6	6	Select Care Drugs	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																		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	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6	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					2.74	85.00		255.00								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	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					0.00	0.00		0.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H4346	008	0	1	01	01	H4346_008_0	6	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.40	12.50		37.50					.24	7.50		22.50								18.75																		12.50				.40	12.50		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	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		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, Select Care Drugs										1		
H4346	008	0	1	01	01	H4346_008_0	6	6	Select Care Drugs	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																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													491.00	33							491.00	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	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.45	45.00		135.00					1.29	40.00		120.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6	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					2.74	85.00		255.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	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									.50	15.50		46.50					.33	10.50		31.50								26.25																		15.50				.50	15.50		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									1.45	45.00		135.00					1.29	40.00		120.00								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									3.06	95.00		285.00					2.90	90.00		270.00								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													491.00	33							491.00	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									0.32	10.00		30.00					0.16	5.00		15.00								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	6	Select Care Drugs	1	4	010010	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												
H4407	002	0	1	01	01	H4407_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		9.00																		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	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					622.01	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	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		36.00																		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	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		255.00																		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	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		135.00																		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	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		36.00																		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	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		9.00																		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	5	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	.10	3.00	6.00	9.00																					0.10	3.00		9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	002	0	1	01	01	H4454_002_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	.10	3.00	6.00	9.00																					0.10	3.00		9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	002	0	1	01	01	H4454_002_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	.40	12.00	24.00	36.00																					0.40	12.00		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	002	0	1	01	01	H4454_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	.40	12.00	24.00	36.00																					0.40	12.00		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	002	0	1	01	01	H4454_002_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		135.00																		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	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		240.00																		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	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					548.26	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_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		9.00																		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	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		9.00																		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	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		36.00																		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	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		36.00																		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	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		135.00																		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	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		240.00																		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	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					576.71	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	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		15.00																		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	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		15.00																		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	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		36.00																		12.00				0.38	12.00		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	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		36.00																		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	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		135.00																		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	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		240.00																		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	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					489.99	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	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		9.00																		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	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		9.00																		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	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		36.00																		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	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		36.00																		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	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		135.00																		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	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		240.00																		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	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					636.91	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	033	0	1	01	01	H4454_033_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		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	033	0	1	01	01	H4454_033_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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	033	0	1	01	01	H4454_033_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		240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	033	0	1	01	01	H4454_033_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					548.26	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	033	0	1	01	01	H4454_033_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		9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	033	0	1	01	01	H4454_033_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		9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	033	0	1	01	01	H4454_033_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		36.00																		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	2	5	Specialty Tier	1	3	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												
H4456	010	0	1	01	01	H4456_010_0	2	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							125.00				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	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	010	0	1	01	01	H4456_010_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	010	0	1	01	01	H4456_010_0	2	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							275.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	013	0	1	01	01	H4456_013_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				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	2	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							125.00				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	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					736.00	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	021	0	1	01	01	H4456_021_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	021	0	1	01	01	H4456_021_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	021	0	1	01	01	H4456_021_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	021	0	1	01	01	H4456_021_0	2	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												
H4456	025	0	1	01	01	H4456_025_0	2	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							275.00				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	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	025	0	1	01	01	H4456_025_0	2	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																															24.00							16.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	025	0	1	01	01	H4456_025_0	2	5	Specialty Tier	1	3	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												
H4461	018	0	1	01	01	H4461_018_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	018	0	1	01	01	H4461_018_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	018	0	1	01	01	H4461_018_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		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												
H4461	018	0	1	01	01	H4461_018_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		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												
H4461	018	0	1	01	01	H4461_018_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	018	0	1	01	01	H4461_018_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	018	0	1	01	01	H4461_018_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	018	0	1	01	01	H4461_018_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		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										2	3	
H4461	018	0	1	01	01	H4461_018_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		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										2	3	
H4461	018	0	1	01	01	H4461_018_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
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	1.43	43.00		129.00																												1.43	43.00		129.00				1.43	43.00		119.00				43.00				1.38	43.00		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		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												
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	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						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	025	0	1	01	01	H4461_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	025	0	1	01	01	H4461_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		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												
H4461	025	0	1	01	01	H4461_025_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		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												
H4461	025	0	1	01	01	H4461_025_0	3	5	Specialty Tier	3	4	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										2	3	
H4461	025	0	1	01	01	H4461_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	025	0	1	01	01	H4461_025_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	025	0	1	01	01	H4461_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		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										2	3	
H4461	025	0	1	01	01	H4461_025_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		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										2	3	
H4461	025	0	1	01	01	H4461_025_0	3	5	Specialty Tier	1	4	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												
H4461	029	0	1	01	01	H4461_029_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.63	19.00		57.00																												0.63	19.00		57.00				0.63	19.00		0.00				19.00				0.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_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		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												
H4461	029	0	1	01	01	H4461_029_0	5	5	Specialty Tier	1	3	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												
H4461	029	0	1	01	01	H4461_029_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		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												
H4461	030	1	1	01	01	H4461_030_1	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	3	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		27.00				0.30	9.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	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		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												
H4461	030	1	1	01	01	H4461_030_1	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		270.00				3.00	90.00		260.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	030	1	1	01	01	H4461_030_1	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	030	1	1	01	01	H4461_030_1	3	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		27.00				0.30	9.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	030	1	1	01	01	H4461_030_1	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		270.00				3.00	90.00		260.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	030	1	1	01	01	H4461_030_1	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		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										2	3	
H4461	030	1	1	01	01	H4461_030_1	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	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		270.00				3.00	90.00		260.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	030	2	1	01	01	H4461_030_2	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	030	2	1	01	01	H4461_030_2	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	3	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		27.00				0.30	9.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	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		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												
H4461	030	2	1	01	01	H4461_030_2	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		270.00				3.00	90.00		260.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	030	2	1	01	01	H4461_030_2	3	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		27.00				0.30	9.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	030	2	1	01	01	H4461_030_2	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		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										2	3	
H4461	030	3	1	01	01	H4461_030_3	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		270.00				3.00	90.00		260.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	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		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												
H4461	030	3	1	01	01	H4461_030_3	3	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		27.00				0.30	9.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	030	3	1	01	01	H4461_030_3	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	030	3	1	01	01	H4461_030_3	3	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		27.00				0.30	9.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	030	3	1	01	01	H4461_030_3	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		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										2	3	
H4461	030	3	1	01	01	H4461_030_3	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		270.00				3.00	90.00		260.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	030	3	1	01	01	H4461_030_3	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	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		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												
H4461	031	1	1	01	01	H4461_031_1	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		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												
H4461	031	1	1	01	01	H4461_031_1	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	031	1	1	01	01	H4461_031_1	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		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										2	3	
H4461	031	1	1	01	01	H4461_031_1	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		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										2	3	
H4461	031	1	1	01	01	H4461_031_1	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	031	1	1	01	01	H4461_031_1	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	031	2	1	01	01	H4461_031_2	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	031	2	1	01	01	H4461_031_2	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		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										2	3	
H4461	031	2	1	01	01	H4461_031_2	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		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										2	3	
H4461	031	2	1	01	01	H4461_031_2	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	031	2	1	01	01	H4461_031_2	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		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												
H4461	031	2	1	01	01	H4461_031_2	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		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												
H4461	031	2	1	01	01	H4461_031_2	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	031	2	1	01	01	H4461_031_2	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	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		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										2	3	
H4461	031	3	1	01	01	H4461_031_3	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	031	3	1	01	01	H4461_031_3	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		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										2	3	
H4461	031	3	1	01	01	H4461_031_3	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	031	3	1	01	01	H4461_031_3	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	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		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												
H4461	031	3	1	01	01	H4461_031_3	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		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												
H4461	031	3	1	01	01	H4461_031_3	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4465	001	0	1	48	05	H4465_001_0	4	1	Generic Drugs	1	4	010000			111		01	111		1	30	60	90				2	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H4465	001	0	1	48	05	H4465_001_0	4	2	Brand Drugs	1	4	000010			111		01	111		1	30	60	90				2	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H4465	001	0	1	48	05	H4465_001_0	4	3	Non-Medicare Rx Drugs	1	4	010010			111		01	111		1	30	60	90				2	30	60	90				30		34																																																					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			
H4465	001	0	1	48	05	H4465_001_0	4	4	Non-Medicare OTC Drugs	1	4	010010			111		01	111		1	30	60	90				2	30	60	90				30		34																																																					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			
H4506	003	0	1	01	01	H4506_003_0	7	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		100.00				1.33	40.00		40.00				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	7	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	7	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	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												
H4506	003	0	1	01	01	H4506_003_0	7	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		200.00				2.67	80.00		80.00				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	7	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		100.00				1.33	40.00		40.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	7	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	7	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	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		100.00				1.33	40.00		40.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
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		200.00				2.67	80.00		80.00				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		100.00				1.33	40.00		40.00				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	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												
H4510	012	0	1	01	01	H4510_012_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		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										2	3	
H4510	012	0	1	01	01	H4510_012_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4510	012	0	1	01	01	H4510_012_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	012	0	1	01	01	H4510_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		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										2	3	
H4510	012	0	1	01	01	H4510_012_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		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												
H4510	012	0	1	01	01	H4510_012_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	012	0	1	01	01	H4510_012_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		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												
H4510	012	0	1	01	01	H4510_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		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												
H4510	012	0	1	01	01	H4510_012_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	012	0	1	01	01	H4510_012_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		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										2	3	
H4510	015	0	1	01	01	H4510_015_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																												1.43	43.00		129.00				1.43	43.00		119.00				43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	015	0	1	01	01	H4510_015_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4510	015	0	1	01	01	H4510_015_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	015	0	1	01	01	H4510_015_0	3	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		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										2	3	
H4510	015	0	1	01	01	H4510_015_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		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										2	3	
H4510	015	0	1	01	01	H4510_015_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		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												
H4510	015	0	1	01	01	H4510_015_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																												1.43	43.00		129.00				1.43	43.00		119.00				43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	015	0	1	01	01	H4510_015_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	015	0	1	01	01	H4510_015_0	3	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		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												
H4510	015	0	1	01	01	H4510_015_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	018	0	1	01	01	H4510_018_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		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										2	3	
H4510	018	0	1	01	01	H4510_018_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4510	018	0	1	01	01	H4510_018_0	3	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		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										2	3	
H4510	018	0	1	01	01	H4510_018_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	018	0	1	01	01	H4510_018_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		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												
H4510	018	0	1	01	01	H4510_018_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		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												
H4510	018	0	1	01	01	H4510_018_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	018	0	1	01	01	H4510_018_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																												0.06	2.00		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												
H4510	018	0	1	01	01	H4510_018_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	018	0	1	01	01	H4510_018_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		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										2	3	
H4510	022	0	1	01	01	H4510_022_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		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												
H4510	022	0	1	01	01	H4510_022_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		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												
H4510	022	0	1	01	01	H4510_022_0	3	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		18.00				0.20	6.00		0.00				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	3	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		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												
H4510	022	0	1	01	01	H4510_022_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	3	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		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										2	3	
H4510	022	0	1	01	01	H4510_022_0	3	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		18.00				0.20	6.00		0.00				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	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		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										2	3	
H4510	022	0	1	01	01	H4510_022_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		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										2	3	
H4510	022	0	1	01	01	H4510_022_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H4510	027	0	1	01	01	H4510_027_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		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												
H4510	027	0	1	01	01	H4510_027_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		30.00				0.33	10.00		0.00				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	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		15.00				0.16	5.00		0.00				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	3	5	Specialty Tier	1	4	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												
H4510	027	0	1	01	01	H4510_027_0	3	5	Specialty Tier	3	4	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										2	3	
H4510	027	0	1	01	01	H4510_027_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		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										2	3	
H4510	027	0	1	01	01	H4510_027_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		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										2	3	
H4510	027	0	1	01	01	H4510_027_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		30.00				0.33	10.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	028	0	1	01	01	H4510_028_0	3	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		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												
H4510	028	0	1	01	01	H4510_028_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	028	0	1	01	01	H4510_028_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		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												
H4510	028	0	1	01	01	H4510_028_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		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												
H4510	028	0	1	01	01	H4510_028_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H4510	028	0	1	01	01	H4510_028_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4510	028	0	1	01	01	H4510_028_0	3	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		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										2	3	
H4510	028	0	1	01	01	H4510_028_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	028	0	1	01	01	H4510_028_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		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										2	3	
H4510	029	0	1	01	01	H4510_029_0	3	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		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										2	3	
H4510	029	0	1	01	01	H4510_029_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4510	029	0	1	01	01	H4510_029_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		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										2	3	
H4510	029	0	1	01	01	H4510_029_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		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										2	3	
H4510	029	0	1	01	01	H4510_029_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	029	0	1	01	01	H4510_029_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																												0.06	2.00		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												
H4510	029	0	1	01	01	H4510_029_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	029	0	1	01	01	H4510_029_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		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												
H4510	029	0	1	01	01	H4510_029_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		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												
H4510	029	0	1	01	01	H4510_029_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	030	0	1	01	01	H4510_030_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		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										2	3	
H4510	030	0	1	01	01	H4510_030_0	4	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																												1.43	43.00		129.00				1.43	43.00		119.00				43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	030	0	1	01	01	H4510_030_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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4510	030	0	1	01	01	H4510_030_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		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										2	3	
H4510	030	0	1	01	01	H4510_030_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	030	0	1	01	01	H4510_030_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		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												
H4510	030	0	1	01	01	H4510_030_0	4	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																												1.43	43.00		129.00				1.43	43.00		119.00				43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	030	0	1	01	01	H4510_030_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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	030	0	1	01	01	H4510_030_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		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												
H4510	030	0	1	01	01	H4510_030_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H4510	032	0	1	01	01	H4510_032_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		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										2	3	
H4510	032	0	1	01	01	H4510_032_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4510	032	0	1	01	01	H4510_032_0	3	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		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										2	3	
H4510	032	0	1	01	01	H4510_032_0	3	5	Specialty Tier	1	4	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												
H4510	032	0	1	01	01	H4510_032_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		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												
H4510	032	0	1	01	01	H4510_032_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		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												
H4510	032	0	1	01	01	H4510_032_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	032	0	1	01	01	H4510_032_0	3	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		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												
H4510	032	0	1	01	01	H4510_032_0	3	5	Specialty Tier	3	4	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										2	3	
H4513	024	1	1	01	01	H4513_024_1	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		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4513	024	1	1	01	01	H4513_024_1	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	024	1	1	01	01	H4513_024_1	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					666.39	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	024	1	1	01	01	H4513_024_1	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		180.00																		60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	024	1	1	01	01	H4513_024_1	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		90.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	024	1	1	01	01	H4513_024_1	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		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	024	1	1	01	01	H4513_024_1	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	024	2	1	01	01	H4513_024_2	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		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4513	024	2	1	01	01	H4513_024_2	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	024	2	1	01	01	H4513_024_2	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					666.39	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	024	2	1	01	01	H4513_024_2	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		90.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	024	2	1	01	01	H4513_024_2	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		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	024	2	1	01	01	H4513_024_2	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	024	2	1	01	01	H4513_024_2	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		180.00																		60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	2	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																															24.00							16.00				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	2	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							125.00				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	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					684.00	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4522	001	0	1	04	01	H4522_001_0	2	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							125.00				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	2	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																															24.00							16.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4522	001	0	1	04	01	H4522_001_0	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					772.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	001	0	1	01	01	H4523_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.33	10.00	20.00	30.00					.20	6.00	12.00	18.00												.33	10.00	20.00	30.00				.20	6.00	12.00	18.00					10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	001	0	1	01	01	H4523_001_0	5	3	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	135.00												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												
H4523	001	0	1	01	01	H4523_001_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													41.92	50	50	50					36.71	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	005	0	1	01	01	H4523_005_0	7	3	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	135.00												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												
H4523	005	0	1	01	01	H4523_005_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.20	6.00	12.00	18.00					.06	2.00	4.00	6.00												.20	6.00	12.00	18.00				.06	2.00	4.00	6.00					6.00			.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	005	0	1	01	01	H4523_005_0	7	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	005	0	1	01	01	H4523_005_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.83	50	50	50					34.87	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	005	0	1	01	01	H4523_005_0	7	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	015	0	1	01	01	H4523_015_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.33	10.00	20.00	30.00					.20	6.00	12.00	18.00												.33	10.00	20.00	30.00				.20	6.00	12.00	18.00					10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	015	0	1	01	01	H4523_015_0	5	3	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	135.00												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												
H4523	015	0	1	01	01	H4523_015_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													43.21	50	50	50					40.90	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	016	0	1	01	01	H4523_016_0	3	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	016	0	1	01	01	H4523_016_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.20	6.00	12.00	18.00					.06	2.00	4.00	6.00												.20	6.00	12.00	18.00				.06	2.00	4.00	6.00					6.00			.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	016	0	1	01	01	H4523_016_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													41.65	50	50	50					39.40	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	016	0	1	01	01	H4523_016_0	3	3	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	135.00												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												
H4523	017	0	1	01	01	H4523_017_0	3	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	017	0	1	01	01	H4523_017_0	3	3	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	135.00												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												
H4523	017	0	1	01	01	H4523_017_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.20	6.00	12.00	18.00					.06	2.00	4.00	6.00												.20	6.00	12.00	18.00				.06	2.00	4.00	6.00					6.00			.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	017	0	1	01	01	H4523_017_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													41.07	50	50	50					38.96	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	018	0	1	01	01	H4523_018_0	3	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	018	0	1	01	01	H4523_018_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.33	10.00	20.00	30.00					.20	6.00	12.00	18.00												.33	10.00	20.00	30.00				.20	6.00	12.00	18.00					10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	018	0	1	01	01	H4523_018_0	3	3	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	135.00												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												
H4523	018	0	1	01	01	H4523_018_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.63	50	50	50					37.59	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	019	0	1	01	01	H4523_019_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	019	0	1	01	01	H4523_019_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.30	9.00	18.00	27.00					.16	5.00	10.00	15.00												.30	9.00	18.00	27.00				.16	5.00	10.00	15.00					9.00			.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	019	0	1	01	01	H4523_019_0	4	3	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	135.00												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												
H4523	019	0	1	01	01	H4523_019_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													41.32	50	50	50					39.08	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	020	0	1	01	01	H4523_020_0	6	1	Preferred Generic	1	4	001000	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												
H4523	020	0	1	01	01	H4523_020_0	6	2	Non-Preferred Generic	1	4	000100	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	15.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	020	0	1	01	01	H4523_020_0	6	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					41.58	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	020	0	1	01	01	H4523_020_0	6	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	021	0	1	01	01	H4523_021_0	5	1	Preferred Generic	1	4	001000	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												
H4523	021	0	1	01	01	H4523_021_0	5	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4523	021	0	1	01	01	H4523_021_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.06	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												
H4523	021	0	1	01	01	H4523_021_0	5	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					40.90	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4525	001	0	1	01	01	H4525_001_0	6	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	001	0	1	01	01	H4525_001_0	6	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	6	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	6	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	012	0	1	01	01	H4525_012_0	5	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	012	0	1	01	01	H4525_012_0	5	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	012	0	1	01	01	H4525_012_0	5	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	012	0	1	01	01	H4525_012_0	5	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	014	0	1	01	01	H4525_014_0	6	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	014	0	1	01	01	H4525_014_0	6	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	014	0	1	01	01	H4525_014_0	6	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	014	0	1	01	01	H4525_014_0	6	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												
H4527	001	0	1	01	01	H4527_001_0	3	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	3	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	3	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					1041.00	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	2	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							125.00				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	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					1044.00	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	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																															27.00							18.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_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							125.00				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	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					872.00	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	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							275.00				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	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	3	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	3	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							125.00				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	3	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							275.00				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	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					1087.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4528	001	0	1	01	01	H4528_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		9.00																		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	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		210.00																		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	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		24.00																		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	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		105.00																		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	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					704.40	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	2	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.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	2	2	Non-Preferred Generic	1	4	000110	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												
H4564	001	0	1	18	06	H4564_001_0	2	3	Preferred Brand	1	4	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	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	2	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	2	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												
H4564	002	0	1	18	06	H4564_002_0	2	2	Non-Preferred Generic	1	4	000110	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												
H4564	002	0	1	18	06	H4564_002_0	2	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.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	2	3	Preferred Brand	1	4	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	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	2	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	2	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												
H4564	003	0	1	18	06	H4564_003_0	2	3	Preferred Brand	1	4	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	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	003	0	1	18	06	H4564_003_0	2	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	003	0	1	18	06	H4564_003_0	2	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												
H4564	003	0	1	18	06	H4564_003_0	2	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.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	2	2	Non-Preferred Generic	1	4	000110	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												
H4564	004	0	1	18	06	H4564_004_0	2	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												
H4564	004	0	1	18	06	H4564_004_0	2	2	Non-Preferred Generic	1	4	000110	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.33	10.00	20.00	30.00																					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	2	3	Preferred Brand	1	4	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	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	2	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	2	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												
H4564	004	0	1	18	06	H4564_004_0	2	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.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	2	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												
H4564	005	0	1	18	06	H4564_005_0	2	2	Non-Preferred Generic	1	4	000110	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.33	10.00	20.00	30.00																					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	2	3	Preferred Brand	1	4	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	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	2	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	2	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												
H4564	005	0	1	18	06	H4564_005_0	2	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.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	006	0	1	18	06	H4564_006_0	3	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.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	006	0	1	18	06	H4564_006_0	3	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												
H4564	006	0	1	18	06	H4564_006_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	006	0	1	18	06	H4564_006_0	3	3	Preferred Brand	1	4	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	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	006	0	1	18	06	H4564_006_0	3	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												
H4564	006	0	1	18	06	H4564_006_0	3	2	Non-Preferred Generic	1	4	000110	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.33	10.00	20.00	30.00																					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	013	0	1	18	06	H4564_013_0	2	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.33	10.00	20.00	30.00																					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	013	0	1	18	06	H4564_013_0	2	2	Non-Preferred Generic	1	3	000110	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.83	25.00	50.00	75.00																					.83	25.00	50.00	50.00																		25.00				.74	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	013	0	1	18	06	H4564_013_0	2	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	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	2	4	Non-Preferred Brand	1	3	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	190.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	013	0	1	18	06	H4564_013_0	2	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	014	0	1	18	06	H4564_014_0	2	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.33	10.00	20.00	30.00																					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	014	0	1	18	06	H4564_014_0	2	2	Non-Preferred Generic	1	3	000110	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.83	25.00	50.00	75.00																					.83	25.00	50.00	50.00																		25.00				.74	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	014	0	1	18	06	H4564_014_0	2	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	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	2	4	Non-Preferred Brand	1	3	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	190.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	014	0	1	18	06	H4564_014_0	2	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	3	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	3	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.33	10.00	20.00	30.00																					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	3	2	Non-Preferred Generic	1	3	000110	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.83	25.00	50.00	75.00																					.83	25.00	50.00	50.00																		25.00				.74	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	3	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	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	3	4	Non-Preferred Brand	1	3	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	190.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	2	3	Preferred Brand	1	4	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	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	2	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	2	2	Non-Preferred Generic	1	4	000110	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												
H4564	017	0	1	18	06	H4564_017_0	2	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.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	017	0	1	18	06	H4564_017_0	2	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												
H4564	018	0	1	18	06	H4564_018_0	2	2	Non-Preferred Generic	1	4	000110	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.33	10.00	20.00	30.00																					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	2	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												
H4564	018	0	1	18	06	H4564_018_0	2	3	Preferred Brand	1	4	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	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	2	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.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	018	0	1	18	06	H4564_018_0	2	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												
H4564	018	0	1	18	06	H4564_018_0	2	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	019	0	1	18	06	H4564_019_0	2	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	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	2	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.33	10.00	20.00	30.00																					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	019	0	1	18	06	H4564_019_0	2	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	019	0	1	18	06	H4564_019_0	2	4	Non-Preferred Brand	1	3	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	190.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	019	0	1	18	06	H4564_019_0	2	2	Non-Preferred Generic	1	3	000110	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.83	25.00	50.00	75.00																					.83	25.00	50.00	50.00																		25.00				.74	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	2	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																															285.00							275.00				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	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							75.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	2	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																															24.00							16.00				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	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					919.00	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	2	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4590	010	0	1	01	01	H4590_010_0	2	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																															24.00							16.00				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	2	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							275.00				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	2	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							125.00				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	2	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																															24.00							16.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					737.00	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					609.00	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	2	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							275.00				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	2	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							125.00				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	2	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																															24.00							16.00				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	2	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4590	037	0	1	01	01	H4590_037_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					707.00	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	2	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																															285.00							275.00				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	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							75.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	2	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																															24.00							16.00				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	2	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																															24.00							16.00				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	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_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							125.00				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	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							275.00				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	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					650.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					650.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	9	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					1154.00	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	9	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	9	3	Preferred Brand	1	3	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												
H4605	002	0	1	04	01	H4605_002_0	9	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.50	15.00		30.00																					0.50	15.00		30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	9	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		20.00																					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	004	0	1	04	01	H4605_004_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.40	12.00		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	9	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												
H4605	004	0	1	04	01	H4605_004_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	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	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		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												
H4738	002	0	1	04	01	H4738_002_0	8	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																					1.40	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	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												
H4738	002	0	1	04	01	H4738_002_0	8	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		225.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4738	002	0	1	04	01	H4738_002_0	8	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	.13	4.00		12.00																					.13	4.00		10.00																		4.00				.12	4.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4740	001	0	1	48	05	H4740_001_0	7	1	Generic Drugs	1	4	010000			110		10	100		1	31		90				1			90					29	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			
H4740	001	0	1	48	05	H4740_001_0	7	2	Brand Drugs	1	4	000010			110		10	100		1	31		90				1			90					29	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			
H4740	001	0	1	48	05	H4740_001_0	7	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		10	100		1	31		90				1			90					29	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			
H4754	004	0	1	04	01	H4754_004_0	7	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4754	004	0	1	04	01	H4754_004_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4754	004	0	1	04	01	H4754_004_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					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		
H4754	004	0	1	04	01	H4754_004_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						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	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		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	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		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	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	004	0	1	04	01	H4754_004_0	7	4	Non-Preferred Brand	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4754	004	0	1	04	01	H4754_004_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					0.06	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	007	0	1	04	01	H4754_007_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						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	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		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	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		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	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		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	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					0.06	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	007	0	1	04	01	H4754_007_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					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		
H4754	007	0	1	04	01	H4754_007_0	7	4	Non-Preferred Brand	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4754	007	0	1	04	01	H4754_007_0	7	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4754	007	0	1	04	01	H4754_007_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4754	009	0	1	04	01	H4754_009_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					0.06	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	009	0	1	04	01	H4754_009_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		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	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4754	009	0	1	04	01	H4754_009_0	7	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4754	009	0	1	04	01	H4754_009_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4754	009	0	1	04	01	H4754_009_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					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		
H4754	009	0	1	04	01	H4754_009_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	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	30		90				2	30		90				30		31	3.16	95.00		285.00																					3.16	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	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		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	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					0.06	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	011	0	1	04	01	H4754_011_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.06	2.00		6.00																					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		
H4754	011	0	1	04	01	H4754_011_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4754	011	0	1	04	01	H4754_011_0	7	3	Preferred Brand	3	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		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4754	011	0	1	04	01	H4754_011_0	7	4	Non-Preferred Brand	3	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		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4754	011	0	1	04	01	H4754_011_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		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	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		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	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.40	12.00		36.00																					.40	12.00		36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	011	0	1	04	01	H4754_011_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4866	003	0	1	01	01	H4866_003_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		12.00																								6.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4866	003	0	1	01	01	H4866_003_0	11	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.27	8.00		24.00																								12.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4866	003	0	1	01	01	H4866_003_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																								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	11	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												
H4866	003	0	1	01	01	H4866_003_0	11	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												
H4875	016	1	1	04	01	H4875_016_1	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					388.74	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	7	4	Non-Preferred Brand	1	4	110000	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	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	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	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	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	12.00																					0.13	4.00	8.00	10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	7	2	Non-Preferred Generic	1	4	000110	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	30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	5	4	Non-Preferred Brand	1	4	110000	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	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	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	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	5	2	Non-Preferred Generic	1	4	000110	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	30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	5	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	10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					388.74	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					388.74	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	5	4	Non-Preferred Brand	1	4	110000	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	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	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	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	5	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	10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	5	2	Non-Preferred Generic	1	4	000110	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	30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	5	4	Non-Preferred Brand	1	4	110000	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	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	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	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	5	2	Non-Preferred Generic	1	4	000110	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	30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	5	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	10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					388.74	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	5	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	10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	5	2	Non-Preferred Generic	1	4	000110	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	30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	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	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	5	4	Non-Preferred Brand	1	4	110000	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	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					388.74	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	7	4	Non-Preferred Brand	1	4	110000	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	212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	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	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												
H4875	017	1	1	04	01	H4875_017_1	7	2	Non-Preferred Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.30	9.00	18.00	27.00																					0.30	9.00	18.00	22.50																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	7	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												
H4875	017	1	1	04	01	H4875_017_1	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					494.45	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	5	4	Non-Preferred Brand	1	4	110000	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	212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	5	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												
H4875	017	2	1	04	01	H4875_017_2	5	2	Non-Preferred Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.30	9.00	18.00	27.00																					0.30	9.00	18.00	22.50																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	5	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	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					494.45	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	5	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	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	5	2	Non-Preferred Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.30	9.00	18.00	27.00																					0.30	9.00	18.00	22.50																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	5	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												
H4875	017	3	1	04	01	H4875_017_3	5	4	Non-Preferred Brand	1	4	110000	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	212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					494.45	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	5	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	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	5	2	Non-Preferred Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.30	9.00	18.00	27.00																					0.30	9.00	18.00	22.50																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	5	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												
H4875	017	4	1	04	01	H4875_017_4	5	4	Non-Preferred Brand	1	4	110000	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	212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					494.45	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	5	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												
H4875	017	5	1	04	01	H4875_017_5	5	2	Non-Preferred Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.30	9.00	18.00	27.00																					0.30	9.00	18.00	22.50																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	5	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	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	5	4	Non-Preferred Brand	1	4	110000	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	212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					494.45	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	8	1	Generic	3	4	010000	1	2	111		01	111		1	30	60	90				1	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4876	001	0	1	04	01	H4876_001_0	8	4	Specialty Tier	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					100.00	33	33	33																					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	8	3	Non-Preferred Brand	1	4	100000	3	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	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	8	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		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	8	1	Generic	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		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												
H4909	014	0	1	04	01	H4909_014_0	14	5	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, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	14	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	14	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	14	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.63	19.00	38.00	57.00					.46	14.00	28.00	42.00					.46	14.00	28.00	28.00																		19.00				.55	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	14	6	Select Care Drugs	1	3	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												
H4909	014	0	1	04	01	H4909_014_0	14	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4910	005	0	1	01	01	H4910_005_0	6	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00	16.00	24.00				0.06	2.00	4.00	6.00					8.00			0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4910	005	0	1	01	01	H4910_005_0	6	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4910	005	0	1	01	01	H4910_005_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													44.78	50	50	50					42.96	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4910	005	0	1	01	01	H4910_005_0	6	3	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	135.00												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												
H4910	005	0	1	01	01	H4910_005_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.36	11.00	22.00	33.00					0.16	5.00	10.00	15.00												0.36	11.00	22.00	33.00				0.16	5.00	10.00	15.00					11.00			0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	001	0	1	01	01	H4922_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	.13	4.00	8.00	12.00																								10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	001	0	1	01	01	H4922_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.33	10.00	20.00	30.00																								25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	001	0	1	01	01	H4922_001_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	.13	4.00	8.00	12.00																								10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4922	001	0	1	01	01	H4922_001_0	7	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31					100.00	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	001	0	1	01	01	H4922_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	95.00	190.00	285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	001	0	1	01	01	H4922_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																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	001	0	1	01	01	H4922_001_0	7	2	Non-Preferred Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.33	10.00	20.00	30.00																								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5005	011	0	1	01	01	H5005_011_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					563.00	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	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	011	0	1	01	01	H5005_011_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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	011	0	1	01	01	H5005_011_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	011	0	1	01	01	H5005_011_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	019	0	1	01	01	H5005_019_0	4	5	Specialty Tier	1	3	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												
H5005	019	0	1	01	01	H5005_019_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	019	0	1	01	01	H5005_019_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	019	0	1	01	01	H5005_019_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							125.00				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	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	9	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.50	15.00		30.00																					0.50	15.00		30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	9	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					1071.00	26																							26																			26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	9	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	9	3	Preferred Brand	1	3	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												
H5009	002	0	1	04	01	H5009_002_0	9	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.26	8.00		16.00																					0.26	8.00		16.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	9	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					1113.00	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	9	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.50	15.00		30.00																					0.50	15.00		30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	9	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	9	3	Preferred Brand	1	3	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												
H5010	002	0	1	04	01	H5010_002_0	9	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.30	9.00		18.00																					0.30	9.00		18.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		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												
H5010	004	0	1	04	01	H5010_004_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	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	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.40	12.00		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_0	9	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												
H5010	004	0	1	04	01	H5010_004_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					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	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	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					715.94	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	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	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	005	0	1	04	01	H5042_005_0	7	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	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					924.95	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	7	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	7	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	7	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	007	0	1	04	01	H5042_007_0	10	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	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					756.00	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	10	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	10	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	10	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	10	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		
H5042	007	0	1	04	01	H5042_007_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, Non-Preferred Brand, Specialty Tier												
H5048	001	0	1	01	01	H5048_001_0	9	3	Preferred Brand	1	4	000001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	001	0	1	01	01	H5048_001_0	9	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																			9.00			.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	001	0	1	01	01	H5048_001_0	9	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00					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												
H5048	001	0	1	01	01	H5048_001_0	9	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													1.00	50	50	50					1.00	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	001	0	1	01	01	H5048_001_0	9	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	002	0	1	01	01	H5048_002_0	11	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00					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												
H5048	002	0	1	01	01	H5048_002_0	11	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00					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												
H5048	002	0	1	01	01	H5048_002_0	11	3	Preferred Brand	1	4	000001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	002	0	1	01	01	H5048_002_0	11	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													1.00	50	50	50					1.00	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	002	0	1	01	01	H5048_002_0	11	5	Specialty Tier	1	4	010001	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.40	21.00	42.00	63.00																					0.40	21.00	42.00	63.00																		21.00				0.40	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.11	4.00	8.00	12.00																					0.11	4.00	8.00	12.00																		4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.28	45.00	90.00	135.00																					1.28	45.00	90.00	135.00																		45.00				1.28	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					847.20	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.94	95.00	190.00	285.00																					1.94	95.00	190.00	285.00																		95.00				1.94	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.11	4.00	8.00	12.00																					0.11	4.00	8.00	12.00																		4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.41	21.00	42.00	63.00																					0.41	21.00	42.00	63.00																		21.00				0.41	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.99	95.00	190.00	285.00																					1.99	95.00	190.00	285.00																		95.00				1.99	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.24	45.00	90.00	135.00																					1.24	45.00	90.00	135.00																		45.00				1.24	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					983.70	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.28	45.00	90.00	135.00																					1.28	45.00	90.00	135.00																		45.00				1.28	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.16	95.00	190.00	285.00																					2.16	95.00	190.00	285.00																		95.00				2.16	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					951.60	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.11	4.00	8.00	12.00																					0.11	4.00	8.00	12.00																		4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.35	21.00	42.00	63.00																					0.35	21.00	42.00	63.00																		21.00				0.35	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	5	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					921.90	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	5	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		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												
H5050	017	0	1	01	01	H5050_017_0	5	2	Non-Preferred Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.25	10.00	20.00	30.00																					0.25	10.00	20.00	30.00																		10.00				0.25	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	5	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.11	37.00	74.00	111.00																					1.11	37.00	74.00	111.00																		37.00				1.11	37.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	5	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.49	87.00	174.00	261.00																					2.49	87.00	174.00	261.00																		87.00				2.49	87.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	018	0	1	01	01	H5050_018_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.42	21.00	42.00	63.00																					0.42	21.00	42.00	63.00																		21.00				0.42	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	018	0	1	01	01	H5050_018_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1021.20	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	018	0	1	01	01	H5050_018_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.51	95.00	190.00	285.00																					2.51	95.00	190.00	285.00																		95.00				2.51	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	018	0	1	01	01	H5050_018_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.34	45.00	90.00	135.00																					1.34	45.00	90.00	135.00																		45.00				1.34	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	018	0	1	01	01	H5050_018_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.11	4.00	8.00	12.00																					0.11	4.00	8.00	12.00																		4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	5	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.17	40.00	80.00	120.00																					1.17	40.00	80.00	120.00																		40.00				1.17	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	5	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		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												
H5050	019	0	1	01	01	H5050_019_0	5	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					996.60	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	5	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.22	90.00	180.00	270.00																					2.22	90.00	180.00	270.00																		90.00				2.22	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	5	2	Non-Preferred Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.25	10.00	20.00	30.00																					0.25	10.00	20.00	30.00																		10.00				0.25	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	8	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					.96	29.00		87.00												1.10	33.00		99.00				.96	29.00		72.50				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_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				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	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	8	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					.96	29.00		87.00												1.10	33.00		99.00				.96	29.00		72.50				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	002	0	1	01	01	H5087_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				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	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.16	5.00		15.00					0.00	0.00		0.00												0.16	5.00		15.00				0.00	0.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	8	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					.33	10.00		30.00												0.50	15.00		45.00				0.33	10.00		25.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	8	1	Preferred Generic	3	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.16	5.00		15.00					0.00	0.00		0.00												0.16	5.00		15.00				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		
H5087	010	0	1	01	01	H5087_010_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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									1.00	30.00		90.00					0.33	10.00		30.00												1.00	30.00		90.00				0.33	10.00		25.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.20	6.00		18.00					.10	3.00		9.00												0.20	6.00		18.00				.10	3.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.60	78.00		234.00												3.16	95.00		285.00				2.60	78.00		195.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	8	1	Preferred Generic	3	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.20	6.00		18.00					0.10	3.00		9.00												0.20	6.00		18.00				0.10	3.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	010	0	1	01	01	H5087_010_0	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.83	25.00		75.00					0.50	15.00		45.00												0.83	25.00		75.00				0.50	15.00		37.50				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	011	0	1	01	01	H5087_011_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.26	8.00		24.00					.13	4.00		12.00												0.26	8.00		24.00				.13	4.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	011	0	1	01	01	H5087_011_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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	8	1	Preferred Generic	3	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.26	8.00		24.00					0.13	4.00		12.00												0.26	8.00		24.00				0.13	4.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	012	0	1	01	01	H5087_012_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.83	25.00		75.00					.23	7.00		21.00												0.83	25.00		75.00				.23	7.00		17.50				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	012	0	1	01	01	H5087_012_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.26	8.00		24.00					0.00	0.00		0.00												0.26	8.00		24.00				0.00	0.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	012	0	1	01	01	H5087_012_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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	8	1	Preferred Generic	3	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.26	8.00		24.00					.13	4.00		12.00												0.26	8.00		24.00				.13	4.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	012	0	1	01	01	H5087_012_0	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.26	8.00		24.00					0.00	0.00		0.00												0.26	8.00		24.00				0.00	0.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	014	0	1	01	01	H5087_014_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.73	22.00		66.00					0.16	5.00		15.00												0.73	22.00		66.00				0.16	5.00		12.50				22.00				0.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	014	0	1	01	01	H5087_014_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	8	1	Preferred Generic	3	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.26	8.00		24.00					0.13	4.00		12.00												0.26	8.00		24.00				0.13	4.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	015	0	1	01	01	H5087_015_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	8	1	Preferred Generic	3	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.26	8.00		24.00					.06	2.00		6.00												0.26	8.00		24.00				.06	2.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	015	0	1	01	01	H5087_015_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.26	8.00		24.00					.06	2.00		6.00												0.26	8.00		24.00				0.06	2.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	015	0	1	01	01	H5087_015_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.83	25.00		75.00					0.50	15.00		45.00												0.83	25.00		75.00				0.50	15.00		37.50				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	015	0	1	01	01	H5087_015_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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.83	25.00		75.00					0.50	15.00		45.00												0.83	25.00		75.00				0.50	15.00		37.50				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.26	8.00		24.00					.13	4.00		12.00												0.26	8.00		24.00				.13	4.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	8	1	Preferred Generic	3	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.26	8.00		24.00					0.13	4.00		12.00												0.26	8.00		24.00				0.13	4.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	017	0	1	01	01	H5087_017_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_0	8	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					.96	29.00		87.00												1.10	33.00		99.00				.96	29.00		72.50				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_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				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	017	0	1	01	01	H5087_017_0	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	018	0	1	01	01	H5087_018_0	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	018	0	1	01	01	H5087_018_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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	018	0	1	01	01	H5087_018_0	8	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					.96	29.00		87.00												1.10	33.00		99.00				.96	29.00		72.50				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	018	0	1	01	01	H5087_018_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				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	018	0	1	01	01	H5087_018_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	020	0	1	01	01	H5087_020_0	8	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	020	0	1	01	01	H5087_020_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	020	0	1	01	01	H5087_020_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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	020	0	1	01	01	H5087_020_0	8	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					.96	29.00		87.00												1.10	33.00		99.00				.96	29.00		72.50				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	020	0	1	01	01	H5087_020_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				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	11	1	Preferred Generic	1	4	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												
H5106	013	0	1	04	01	H5106_013_0	11	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.38	12.00		36.00																								30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	11	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	11	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	013	0	1	04	01	H5106_013_0	11	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1375.67	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	13	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.38	12.00		36.00																								30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	13	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	13	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	13	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					936.26	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	7	2	Non-Preferred Generic	1	3	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.27	8.00	16.00	24.00																								16.00																		8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	7	1	Preferred Generic	1	3	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	7	3	Preferred Brand	1	3	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	7	5	Specialty Tier	1	3	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												
H5141	001	0	1	04	01	H5141_001_0	7	4	Non-Preferred Brand	1	3	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	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												
H5141	004	0	1	04	01	H5141_004_0	6	1	Preferred Generic	1	3	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	004	0	1	04	01	H5141_004_0	6	2	Non-Preferred Generic	1	3	000100	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				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	6	3	Preferred Brand	1	3	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	004	0	1	04	01	H5141_004_0	6	4	Non-Preferred Brand	1	3	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	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												
H5141	004	0	1	04	01	H5141_004_0	6	5	Specialty Tier	1	3	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	010	0	1	02	01	H5151_010_0	3	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	010	0	1	02	01	H5151_010_0	3	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	010	0	1	02	01	H5151_010_0	3	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	010	0	1	02	01	H5151_010_0	3	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	010	0	1	02	01	H5151_010_0	3	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	011	1	1	01	01	H5151_011_1	5	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	011	1	1	01	01	H5151_011_1	5	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	011	1	1	01	01	H5151_011_1	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																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5151	011	1	1	01	01	H5151_011_1	5	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	011	1	1	01	01	H5151_011_1	5	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	011	2	1	01	01	H5151_011_2	5	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	011	2	1	01	01	H5151_011_2	5	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	011	2	1	01	01	H5151_011_2	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																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5151	011	2	1	01	01	H5151_011_2	5	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	011	2	1	01	01	H5151_011_2	5	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		
H5172	002	0	1	48	05	H5172_002_0	2	2	Brand Drugs	1	4	000010			110		01	110		1	31		93				2	31		93				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
H5172	002	0	1	48	05	H5172_002_0	2	4	Non-Medicare OTC Drugs	1	4	010010			110		01	110		1	31		93				1	31		93				31		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			
H5172	002	0	1	48	05	H5172_002_0	2	3	Non-Medicare Rx Drugs	1	4	010010			110		01	110		1	31		93				1	31		93				31		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			
H5172	002	0	1	48	05	H5172_002_0	2	1	Generic Drugs	1	4	010000			110		01	110		1	31		93				2	31		93				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5190	001	0	1	01	01	H5190_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												
H5190	001	0	1	01	01	H5190_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												
H5190	001	0	1	01	01	H5190_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												
H5190	001	0	1	01	01	H5190_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												
H5190	002	0	1	01	01	H5190_002_0	9	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	9	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	9	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	002	0	1	01	01	H5190_002_0	9	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	9	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	9	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	9	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	9	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	004	0	1	01	01	H5190_004_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	004	0	1	01	01	H5190_004_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	004	0	1	01	01	H5190_004_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	004	0	1	01	01	H5190_004_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	004	0	1	01	01	H5190_004_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		
H5211	002	0	1	02	01	H5211_002_0	9	2	Non-Preferred Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.63	19.00	38.00	57.00																					.63	19.00	38.00	57.00																		19.00				0.56	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	9	1	Preferred Generic	1	3	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	18.00																		6.00				.18	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	9	6	Vaccines	1	3	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	002	0	1	02	01	H5211_002_0	9	3	Preferred Brand	1	3	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	9	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	9	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					1671.00	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	9	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.17	5.00	10.00	15.00																					.17	5.00	10.00	15.00																		5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	9	2	Non-Preferred Generic	1	3	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	45.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	9	3	Preferred Brand	1	3	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	9	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	9	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					1654.00	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	9	6	Vaccines	1	3	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												
H5215	002	0	1	04	01	H5215_002_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.12	4.00		10.00					.06	2.00		4.00					.06	2.00		4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	6	2	Non-Preferred Generic	1	4	001100	1	2		110	01	110		1				31		90	1	31		90				31		31									.41	13.00		33.00					.25	8.00		20.00					.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	6	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	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.90	90.00		215.00					2.74	85.00		200.00					2.74	85.00		200.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	6	3	Preferred Brand	1	4	000101	1	2		110	01	110		1				31		90	1	31		90				31		31									1.45	45.00		109.00					1.35	42.00		100.00					1.35	42.00		100.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.12	4.00		10.00					.06	2.00		4.00					.06	2.00		4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	7	2	Non-Preferred Generic	1	4	001100	1	2		110	01	110		1				31		90	1	31		90				31		31									.41	13.00		33.00					.25	8.00		20.00					.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	7	3	Preferred Brand	1	4	000101	1	2		110	01	110		1				31		90	1	31		90				31		31									1.45	45.00		109.00					1.35	42.00		100.00					1.35	42.00		100.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.90	90.00		215.00					2.74	85.00		200.00					2.74	85.00		200.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	7	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	007	0	1	04	01	H5215_007_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		8.00					.03	1.00		3.00					.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	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.77	86.00		225.00					2.58	80.00		212.00					2.58	80.00		212.00																		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	7	3	Preferred Brand	1	4	000101	1	2		110	01	110		1				31		90	1	31		90				31		31									1.45	45.00		130.00					1.35	42.00		120.00					1.35	42.00		120.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	7	2	Non-Preferred Generic	1	4	001100	1	2		110	01	110		1				31		90	1	31		90				31		31									.58	18.00		35.00					.41	13.00		30.00					.41	13.00		30.00																		13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	7	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	6	3	Preferred Brand	1	4	000101	1	2		110	01	110		1				31		90	1	31		90				31		31									1.45	45.00		109.00					1.35	42.00		100.00					1.35	42.00		100.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	6	2	Non-Preferred Generic	1	4	001100	1	2		110	01	110		1				31		90	1	31		90				31		31									.41	13.00		33.00					.25	8.00		20.00					.25	8.00		20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.12	4.00		10.00					.06	2.00		4.00					.06	2.00		4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.90	90.00		215.00					2.74	85.00		200.00					2.74	85.00		200.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	6	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												
H5216	001	0	1	04	01	H5216_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		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												
H5216	001	0	1	04	01	H5216_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		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												
H5216	001	0	1	04	01	H5216_001_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				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	3	5	Specialty Tier	3	4	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										2	3	
H5216	001	0	1	04	01	H5216_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	001	0	1	04	01	H5216_001_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		45.00				0.50	15.00		0.00				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	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		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										2	3	
H5216	001	0	1	04	01	H5216_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		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										2	3	
H5216	001	0	1	04	01	H5216_001_0	3	5	Specialty Tier	1	4	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												
H5216	003	0	1	04	01	H5216_003_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		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												
H5216	003	0	1	04	01	H5216_003_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		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												
H5216	003	0	1	04	01	H5216_003_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	003	0	1	04	01	H5216_003_0	3	5	Specialty Tier	1	4	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												
H5216	003	0	1	04	01	H5216_003_0	3	5	Specialty Tier	3	4	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										2	3	
H5216	003	0	1	04	01	H5216_003_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		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										2	3	
H5216	003	0	1	04	01	H5216_003_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		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										2	3	
H5216	003	0	1	04	01	H5216_003_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	006	0	1	04	01	H5216_006_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		18.00				0.20	6.00		0.00				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	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		45.00				0.50	15.00		0.00				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	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		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												
H5216	006	0	1	04	01	H5216_006_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		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												
H5216	006	0	1	04	01	H5216_006_0	3	5	Specialty Tier	3	4	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										2	3	
H5216	006	0	1	04	01	H5216_006_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		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										2	3	
H5216	006	0	1	04	01	H5216_006_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	006	0	1	04	01	H5216_006_0	3	5	Specialty Tier	1	4	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												
H5216	006	0	1	04	01	H5216_006_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		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										2	3	
H5216	009	0	1	04	01	H5216_009_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		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												
H5216	009	0	1	04	01	H5216_009_0	3	5	Specialty Tier	1	4	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												
H5216	009	0	1	04	01	H5216_009_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	009	0	1	04	01	H5216_009_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		45.00				0.50	15.00		0.00				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	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		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										2	3	
H5216	009	0	1	04	01	H5216_009_0	3	5	Specialty Tier	3	4	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										2	3	
H5216	009	0	1	04	01	H5216_009_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		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										2	3	
H5216	009	0	1	04	01	H5216_009_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_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		45.00				0.50	15.00		0.00				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	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		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												
H5216	010	0	1	04	01	H5216_010_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		18.00				0.20	6.00		0.00				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	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		45.00				0.50	15.00		0.00				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	3	5	Specialty Tier	3	4	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										2	3	
H5216	010	0	1	04	01	H5216_010_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		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										2	3	
H5216	010	0	1	04	01	H5216_010_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		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										2	3	
H5216	010	0	1	04	01	H5216_010_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5216	010	0	1	04	01	H5216_010_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	010	0	1	04	01	H5216_010_0	3	5	Specialty Tier	1	4	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												
H5216	010	0	1	04	01	H5216_010_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		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												
H5216	010	0	1	04	01	H5216_010_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		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												
H5253	004	0	1	01	01	H5253_004_0	3	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																															27.00							18.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	004	0	1	01	01	H5253_004_0	3	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	004	0	1	01	01	H5253_004_0	3	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							275.00				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	3	5	Specialty Tier	1	3	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												
H5253	004	0	1	01	01	H5253_004_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					547.00	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	3	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																															33.00							22.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	3	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							125.00				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	3	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							275.00				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	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					505.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	3	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							275.00				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	3	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							125.00				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	3	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																															30.00							20.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	2	3	Preferred Brand	1	3	000001	1	2	111		01			1	30	60	90				1							30		31	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												
H5262	001	0	1	01	01	H5262_001_0	2	2	Non-Preferred Generic	1	3	000100	1	2	111		01			1	30	60	90				1							30		31	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												
H5262	001	0	1	01	01	H5262_001_0	2	1	Preferred Generic	1	3	001000	1	2	111		01			1	30	60	90				1							30		31	0.30	9.00	18.00	27.00																																										9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	2	4	Non-Preferred Brand	1	3	100000	1	2	111		01			1	30	60	90				1							30		31	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												
H5262	001	0	1	01	01	H5262_001_0	2	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31					1251.88	30																																										30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	2	3	Preferred Brand	1	3	000001	1	2	111		01			1	30	60	90				1							30		31	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												
H5262	003	0	1	01	01	H5262_003_0	2	2	Non-Preferred Generic	1	3	000100	1	2	111		01			1	30	60	90				1							30		31	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												
H5262	003	0	1	01	01	H5262_003_0	2	1	Preferred Generic	1	3	001000	1	2	111		01			1	30	60	90				1							30		31	0.30	9.00	18.00	27.00																																										9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	2	4	Non-Preferred Brand	1	3	100000	1	2	111		01			1	30	60	90				1							30		31	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												
H5262	003	0	1	01	01	H5262_003_0	2	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31					1320.78	28																																										28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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/OTC Drugs	1	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
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/OTC Drugs	1	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/OTC Drugs	1	4	010010			010		01	010		1	31							31						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			
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	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	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												
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												
H5302	003	0	1	02	01	H5302_003_0	9	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													43.51	50	50	50					41.22	50	50	50					50	50	50																		50			50	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	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	30.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																			10.00			.32	10.00		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	10	111		1				30	60	90	1	30	60	90					10	31									.83	25.00	50.00	75.00					.66	20.00	40.00	60.00					.66	20.00	40.00	60.00																			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	3	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	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												
H5302	003	0	1	02	01	H5302_003_0	9	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	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	2	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							275.00				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	2	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							125.00				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	2	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																															27.00							18.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	016	0	1	01	01	H5322_016_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															9.00							6.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	016	0	1	01	01	H5322_016_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					500.00	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	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															15.00							10.00				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	3	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																															30.00							20.00				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	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	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																															255.00							245.00				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	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					474.00	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	3	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	019	0	1	02	01	H5322_019_0	3	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																															12.00							8.00				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	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	0.66	20.00		60.00																															60.00							50.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	019	0	1	02	01	H5322_019_0	3	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	019	0	1	02	01	H5322_019_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					102.00	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	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																															255.00							245.00				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	3	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																															30.00							20.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	020	0	1	02	01	H5322_020_0	3	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	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					523.00	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	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	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																															30.00							20.00				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	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	2	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							8.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	021	0	1	02	01	H5322_021_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					499.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	021	0	1	02	01	H5322_021_0	2	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																															225.00							215.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	023	0	1	02	01	H5322_023_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	023	0	1	02	01	H5322_023_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												
H5322	023	0	1	02	01	H5322_023_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							275.00				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	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							125.00				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	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	3	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							275.00				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	3	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							125.00				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	3	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	3	5	Specialty Tier	1	3	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												
H5355	001	0	1	48	05	H5355_001_0	3	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	3	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	0.00	2.65	0.00	2.65	0.00	2.65	0.00	2.65			
H5355	001	0	1	48	05	H5355_001_0	3	2	Brand Drugs	1	4	000010			110		01	110		1	30		90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
H5386	001	0	1	01	01	H5386_001_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		34	0.27	8.00	16.00	24.00																								24.00																		8.00				0.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	001	0	1	01	01	H5386_001_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		34	1.50	45.00	90.00	135.00																								135.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	001	0	1	01	01	H5386_001_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		34	3.17	95.00	190.00	285.00																								285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	001	0	1	01	01	H5386_001_0	9	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		34						33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	001	0	1	01	01	H5386_001_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		34	0.13	4.00	8.00	12.00																								12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	5	1	Generic	3	4	010000	3	2		110	01			1				30		90	2							30		31									0.16	5.00		15.00					0.00	0.00		0.00																										5.00				0.16	5.00		Generic, Brand, Specialty Tier										1		3
H5410	001	0	1	01	01	H5410_001_0	5	1	Generic	1	4	010000	3	2		110	01			1				30		90	2							30		31									0.16	5.00		15.00					0.00	0.00		0.00																										5.00				0.16	5.00		Generic, Brand, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	5	2	Brand	1	4	000010	1	2		110	01			1				30		90	2							30		31									0.33	10.00		30.00					0.00	0.00		0.00																										10.00				0.32	10.00		Generic, Brand, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	5	3	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													931.37	33							931.37	33																										33				33	Generic, 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		36.00																		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		9.00																		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					563.82	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		255.00																		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	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		135.00																		45.00				1.45	45.00		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	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		36.00																		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	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		9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	019	0	1	01	01	H5414_019_0	7	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	019	0	1	01	01	H5414_019_0	7	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					10	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										1		
H5414	019	0	1	01	01	H5414_019_0	7	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					39.44	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	019	0	1	01	01	H5414_019_0	7	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	019	0	1	01	01	H5414_019_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	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												
H5414	019	0	1	01	01	H5414_019_0	7	1	Preferred Generic	1	4	001000	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												
H5414	023	0	1	01	01	H5414_023_0	4	1	Preferred Generic	1	4	001000	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	0.00				0.00	0.00	0.00	0.00					0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	023	0	1	01	01	H5414_023_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00												0.33	10.00	20.00	30.00				0.16	5.00	10.00	15.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	023	0	1	01	01	H5414_023_0	4	3	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					1.33	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												
H5414	023	0	1	01	01	H5414_023_0	4	1	Preferred Generic	3	4	001000	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	0.00				0.00	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		
H5414	023	0	1	01	01	H5414_023_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	023	0	1	01	01	H5414_023_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													35.41	50	50	50					32.99	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	024	0	1	01	01	H5414_024_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													34.24	50	50	50					31.96	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	024	0	1	01	01	H5414_024_0	5	1	Preferred Generic	3	4	001000	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	0.00				0.00	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		
H5414	024	0	1	01	01	H5414_024_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	024	0	1	01	01	H5414_024_0	5	3	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					1.33	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												
H5414	024	0	1	01	01	H5414_024_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00												0.33	10.00	20.00	30.00				0.16	5.00	10.00	15.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	024	0	1	01	01	H5414_024_0	5	1	Preferred Generic	1	4	001000	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	0.00				0.00	0.00	0.00	0.00					0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	025	0	1	01	01	H5414_025_0	4	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	10.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5414	025	0	1	01	01	H5414_025_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	10.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	025	0	1	01	01	H5414_025_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	17.50					0.10	3.00	6.00	7.50												0.23	7.00	14.00	17.50				0.10	3.00	6.00	7.50					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	025	0	1	01	01	H5414_025_0	4	3	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	112.50					1.50	45.00	90.00	112.50												1.50	45.00	90.00	112.50				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												
H5414	025	0	1	01	01	H5414_025_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													42.18	50	50	50					39.59	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	025	0	1	01	01	H5414_025_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	056	0	1	04	01	H5415_056_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H5415	056	0	1	04	01	H5415_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		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										2	3	
H5415	056	0	1	04	01	H5415_056_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		30.00				0.33	10.00		0.00				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	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H5415	056	0	1	04	01	H5415_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		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												
H5415	056	0	1	04	01	H5415_056_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		30.00				0.33	10.00		0.00				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	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		15.00				0.16	5.00		0.00				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	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	070	0	1	04	01	H5415_070_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		30.00				0.33	10.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H5415	070	0	1	04	01	H5415_070_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		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												
H5415	070	0	1	04	01	H5415_070_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		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												
H5415	070	0	1	04	01	H5415_070_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		30.00				0.33	10.00		0.00				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	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		15.00				0.16	5.00		0.00				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	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		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										2	3	
H5420	001	0	1	01	01	H5420_001_0	3	1	Preferred Generic	1	4	001010	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												
H5420	001	0	1	01	01	H5420_001_0	3	2	Preferred Brand	1	4	010001	3	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															15.00							5.00				5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	3	3	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	.83	25.00		75.00																															75.00							65.00				25.00				.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	3	4	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					471.00	33		33																														33							33			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	3	1	Preferred Generic	3	4	001010	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		3
H5420	003	0	1	01	01	H5420_003_0	2	1	Preferred Generic	1	4	001010	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												
H5420	003	0	1	01	01	H5420_003_0	2	2	Preferred Brand	1	4	010001	3	2	110		01		100	1	30		90				1						90	30		31	1.00	30.00		90.00																															90.00							80.00				30.00				.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	2	3	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	2.96	89.00		267.00																															267.00							257.00				89.00				2.87	89.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	2	4	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					445.00	33		33																														33							33			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	2	1	Preferred Generic	3	4	001010	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		3
H5420	006	0	1	02	01	H5420_006_0	3	3	Non-Preferred Brand	1	4	100100	1	1	110		01	100		1	30		90				1			90				30		31					34.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	02	01	H5420_006_0	3	2	Preferred Brand	1	4	010001	1	1	110		01	100		1	30		90				1			90				30		31					41.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	02	01	H5420_006_0	3	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		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	02	01	H5420_006_0	3	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					349.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	02	01	H5420_006_0	3	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		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5422	007	0	1	01	01	H5422_007_0	12	1	Preferred Generic	1	3	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	15.00					0.16	5.00	10.00	10.00																		5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	12	2	Non-Preferred Generic	1	3	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	30.00					0.33	10.00	20.00	20.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	12	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					1.03	31.00	62.00	93.00					1.03	31.00	93.00	93.00																		31.00				0.91	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	12	5	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, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	12	6	Select Care Drugs	1	3	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												
H5422	008	0	1	01	01	H5422_008_0	12	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	12	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.83	25.00	50.00	75.00					0.66	20.00	40.00	60.00					0.66	20.00	40.00	40.00																		25.00				0.73	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	12	5	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, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	12	6	Select Care Drugs	1	3	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												
H5424	001	0	1	04	01	H5424_001_0	2	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							125.00				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	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																															30.00							20.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5424	001	0	1	04	01	H5424_001_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5424	001	0	1	04	01	H5424_001_0	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					633.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5425	001	0	1	01	01	H5425_001_0	8	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	001	0	1	01	01	H5425_001_0	8	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	8	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	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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					677.71	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	7	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	004	0	1	01	01	H5425_004_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	004	0	1	01	01	H5425_004_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					723.95	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	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	245.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.25	8.00	16.00	24.00																					0.25	8.00	16.00	16.00																		8.00				0.25	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	7	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.25	8.00	16.00	24.00																					0.25	8.00	16.00	16.00																		8.00				0.25	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	7	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	005	0	1	01	01	H5425_005_0	7	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	005	0	1	01	01	H5425_005_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	005	0	1	01	01	H5425_005_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.90	90.00	180.00	270.00																					2.90	90.00	180.00	260.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	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	125.00																		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	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	005	0	1	01	01	H5425_005_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					546.59	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	7	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	006	0	1	01	01	H5425_006_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	006	0	1	01	01	H5425_006_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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					601.14	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	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	006	0	1	01	01	H5425_006_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	006	0	1	01	01	H5425_006_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	006	0	1	01	01	H5425_006_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	007	0	1	01	01	H5425_007_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	007	0	1	01	01	H5425_007_0	7	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	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	007	0	1	01	01	H5425_007_0	7	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	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	007	0	1	01	01	H5425_007_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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					501.23	33																							33																			33				33	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	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	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	0.38	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	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	0.38	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										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	0.16	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	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					570.01	33																							33																			33				33	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	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	275.00																		95.00				3.06	95.00		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	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	125.00																		45.00				1.45	45.00		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	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	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	0.16	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	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	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					557.25	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	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	275.00																		95.00				3.06	95.00		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	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	125.00																		45.00				1.45	45.00		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	0.38	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	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	0.38	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										1		
H5425	019	0	1	01	01	H5425_019_0	7	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	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	019	0	1	01	01	H5425_019_0	7	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	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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					540.66	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	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	125.00																		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	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	020	0	1	01	01	H5425_020_0	7	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	7	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	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					487.19	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	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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	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	028	0	1	01	01	H5425_028_0	7	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	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	7	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	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					472.03	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	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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	7	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	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																					0.09	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	7	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	7	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	033	0	1	01	01	H5425_033_0	7	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.38	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										1		
H5425	033	0	1	01	01	H5425_033_0	7	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	033	0	1	01	01	H5425_033_0	7	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												
H5425	033	0	1	01	01	H5425_033_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					598.68	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	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	275.00																		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	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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	7	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	034	0	1	01	01	H5425_034_0	7	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	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	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	034	0	1	01	01	H5425_034_0	7	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	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					637.08	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_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																					0.09	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	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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	7	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	7	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	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	275.00																		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	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																					0.09	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	7	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	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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	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	245.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					526.36	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	7	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	047	0	1	01	01	H5425_047_0	8	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	8	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	8	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	8	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	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					503.08	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	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	275.00																		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	8	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	8	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	047	0	1	01	01	H5425_047_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	125.00																		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	7	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	7	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	7	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	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					653.53	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	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	048	0	1	01	01	H5425_048_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	125.00																		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	7	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	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																					0.09	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	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	275.00																		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	7	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	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	050	0	1	01	01	H5425_050_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	125.00																		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	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	275.00																		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	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					652.84	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	050	0	1	01	01	H5425_050_0	7	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	7	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	7	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	051	0	1	01	01	H5425_051_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	125.00																		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	7	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	7	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	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	275.00																		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	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					526.21	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	7	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												
H5425	052	0	1	01	01	H5425_052_0	7	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	052	0	1	01	01	H5425_052_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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	052	0	1	01	01	H5425_052_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					526.16	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	052	0	1	01	01	H5425_052_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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	052	0	1	01	01	H5425_052_0	7	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	052	0	1	01	01	H5425_052_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.48	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	053	0	1	01	01	H5425_053_0	7	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	053	0	1	01	01	H5425_053_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.48	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	053	0	1	01	01	H5425_053_0	7	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	053	0	1	01	01	H5425_053_0	7	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	053	0	1	01	01	H5425_053_0	7	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	053	0	1	01	01	H5425_053_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					503.27	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	7	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	054	0	1	01	01	H5425_054_0	7	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	054	0	1	01	01	H5425_054_0	7	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	054	0	1	01	01	H5425_054_0	7	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	054	0	1	01	01	H5425_054_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					652.65	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.48	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	054	0	1	01	01	H5425_054_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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_0	7	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	055	0	1	01	01	H5425_055_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	055	0	1	01	01	H5425_055_0	7	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	055	0	1	01	01	H5425_055_0	7	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	055	0	1	01	01	H5425_055_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					502.84	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_0	7	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																					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	055	0	1	01	01	H5425_055_0	7	1	Preferred Generic	1	4	001000	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	10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	056	0	1	01	01	H5425_056_0	7	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				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	056	0	1	01	01	H5425_056_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					635.58	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	056	0	1	01	01	H5425_056_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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	056	0	1	01	01	H5425_056_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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	056	0	1	01	01	H5425_056_0	7	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	056	0	1	01	01	H5425_056_0	7	1	Preferred Generic	3	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				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	056	0	1	01	01	H5425_056_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	059	0	1	01	01	H5425_059_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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	059	0	1	01	01	H5425_059_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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	059	0	1	01	01	H5425_059_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.48	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	059	0	1	01	01	H5425_059_0	7	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	059	0	1	01	01	H5425_059_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					503.27	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	059	0	1	01	01	H5425_059_0	7	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	059	0	1	01	01	H5425_059_0	7	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	059	0	1	01	01	H5425_059_0	7	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	060	0	1	01	01	H5425_060_0	7	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	060	0	1	01	01	H5425_060_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.48	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	060	0	1	01	01	H5425_060_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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	060	0	1	01	01	H5425_060_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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	060	0	1	01	01	H5425_060_0	7	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	060	0	1	01	01	H5425_060_0	7	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	060	0	1	01	01	H5425_060_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					652.65	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	060	0	1	01	01	H5425_060_0	7	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		
H5427	059	0	1	01	01	H5427_059_0	8	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	059	0	1	01	01	H5427_059_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												
H5427	059	0	1	01	01	H5427_059_0	8	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	059	0	1	01	01	H5427_059_0	8	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	059	0	1	01	01	H5427_059_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												
H5427	060	0	1	01	01	H5427_060_0	8	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	060	0	1	01	01	H5427_060_0	8	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	060	0	1	01	01	H5427_060_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												
H5427	060	0	1	01	01	H5427_060_0	8	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		170.00																		85.00				2.74	85.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_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												
H5427	070	0	1	01	01	H5427_070_0	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	.83	25.00		75.00																					.80	25.00		50.00																		25.00				.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	070	0	1	01	01	H5427_070_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												
H5427	070	0	1	01	01	H5427_070_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												
H5427	070	0	1	01	01	H5427_070_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												
H5427	070	0	1	01	01	H5427_070_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		3
H5427	072	0	1	01	01	H5427_072_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				.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	072	0	1	01	01	H5427_072_0	8	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	072	0	1	01	01	H5427_072_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												
H5427	072	0	1	01	01	H5427_072_0	8	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	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												
H5427	077	0	1	01	01	H5427_077_0	8	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	077	0	1	01	01	H5427_077_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												
H5427	077	0	1	01	01	H5427_077_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				.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	8	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	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												
H5427	082	0	1	01	01	H5427_082_0	8	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	082	0	1	01	01	H5427_082_0	8	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	082	0	1	01	01	H5427_082_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												
H5427	082	0	1	01	01	H5427_082_0	8	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	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												
H5427	083	0	1	01	01	H5427_083_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												
H5427	083	0	1	01	01	H5427_083_0	8	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	083	0	1	01	01	H5427_083_0	8	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	083	0	1	01	01	H5427_083_0	8	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	083	0	1	01	01	H5427_083_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												
H5427	088	0	1	01	01	H5427_088_0	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	.83	25.00		75.00																					.83	25.00		50.00																		25.00				.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_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												
H5427	088	0	1	01	01	H5427_088_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												
H5427	088	0	1	01	01	H5427_088_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		3
H5427	088	0	1	01	01	H5427_088_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												
H5427	089	0	1	01	01	H5427_089_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												
H5427	089	0	1	01	01	H5427_089_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				.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_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												
H5427	089	0	1	01	01	H5427_089_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												
H5427	089	0	1	01	01	H5427_089_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		3
H5427	091	0	1	01	01	H5427_091_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												
H5427	091	0	1	01	01	H5427_091_0	8	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	091	0	1	01	01	H5427_091_0	8	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	091	0	1	01	01	H5427_091_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												
H5427	091	0	1	01	01	H5427_091_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		3
H5427	092	0	1	01	01	H5427_092_0	8	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				2.28	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_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				.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_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												
H5427	092	0	1	01	01	H5427_092_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												
H5427	092	0	1	01	01	H5427_092_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		3
H5427	093	0	1	01	01	H5427_093_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												
H5427	093	0	1	01	01	H5427_093_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				.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	8	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												
H5427	093	0	1	01	01	H5427_093_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												
H5427	093	0	1	01	01	H5427_093_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		3
H5427	094	0	1	01	01	H5427_094_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												
H5427	094	0	1	01	01	H5427_094_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		3
H5427	094	0	1	01	01	H5427_094_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				.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	8	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	094	0	1	01	01	H5427_094_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												
H5428	001	0	1	01	01	H5428_001_0	5	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	5	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	7	1	Preferred Generic	1	4	001000	1	1		110	01			1				30		90	2							30		31													5.46	25		25					0.00	0		0																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	7	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	2							30		31													342.21	25		25					342.21	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	7	4	Non-Preferred Brand	1	4	100100	1	1		110	01			1				30		90	2							30		31													63.16	25		25					63.16	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	7	3	Preferred Brand	1	4	000001	1	1		110	01			1				30		90	2							30		31													62.59	25		25					62.59	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	7	2	Non-Preferred Generic	1	4	000100	1	1		110	01			1				30		90	2							30		31													5.66	25		25					5.66	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	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1127.88	33							1127.88	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	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	001	0	1	01	01	H5431_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2		010	01			1				30										30		31									1.66	50.00							0.00	0.00																												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	7	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	7	2	Non-Preferred Generic	1	4	000100	1	2		010	01			1				30										30		31									.33	10.00							0.00	0.00																												10.00				.32	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	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	001	0	1	01	01	H5431_001_0	7	2	Non-Preferred Generic	3	4	000100	1	2		010	01			1				30										30		31									.33	10.00							0.00	0.00																												10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	001	0	1	01	01	H5431_001_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	006	0	1	01	01	H5431_006_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1554.18	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	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		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	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		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	7	4	Non-Preferred Brand	1	4	100000	1	1	010		01			1	30													30		31					24.11	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	7	3	Preferred Brand	1	4	000001	1	1	010		01			1	30													30		31					40.24	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	7	2	Non-Preferred Generic	1	4	000100	1	1	010		01			1	30													30		31					3.90	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	7	1	Preferred Generic	1	4	001000	1	1	010		01			1	30													30		31					3.90	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	011	0	1	02	01	H5431_011_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1429.86	33							1429.86	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	011	0	1	02	01	H5431_011_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	011	0	1	02	01	H5431_011_0	6	2	Non-Preferred Generic	1	4	000100	1	2		010	01			1				30										30		31									.32	10.00							0.00	0.00																												10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	011	0	1	02	01	H5431_011_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	011	0	1	02	01	H5431_011_0	6	4	Non-Preferred Brand	1	4	100000	1	2		010	01			1				30										30		31									1.61	50.00							0.00	0.00																												50.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	011	0	1	02	01	H5431_011_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	011	0	1	02	01	H5431_011_0	6	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	011	0	1	02	01	H5431_011_0	6	2	Non-Preferred Generic	3	4	000100	1	2		010	01			1				30										30		31									.32	10.00							0.00	0.00																												10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	012	0	1	01	01	H5431_012_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	012	0	1	01	01	H5431_012_0	6	4	Non-Preferred Brand	1	4	100000	1	2		010	01			1				30										30		31									1.61	50.00							.96	30.00																												50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	012	0	1	01	01	H5431_012_0	6	2	Non-Preferred Generic	1	4	000100	1	2		010	01			1				30										30		31									.32	10.00							0.00	0.00																												10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	012	0	1	01	01	H5431_012_0	6	3	Preferred Brand	1	4	000001	1	2		010	01			1				30										30		31									.80	25.00							0.48	15.00																												25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	012	0	1	01	01	H5431_012_0	6	2	Non-Preferred Generic	3	4	000100	1	2		010	01			1				30										30		31									.32	10.00							0.00	0.00																												10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	012	0	1	01	01	H5431_012_0	6	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	012	0	1	01	01	H5431_012_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	012	0	1	01	01	H5431_012_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1121.01	33							1121.04	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	10	2	Brand	1	2	000010	1	1	111		01			1	30	60	90				1							30		31					64.51	25	25	25																																								25				25	Generic, Brand												
H5433	001	0	1	01	01	H5433_001_0	10	1	Generic	1	2	010000	1	2	111		01			1	30	60	90				1							30		31	0.15	4.50	9.00	13.50																																										4.50				.15	4.50		Generic, Brand												
H5434	002	0	1	04	01	H5434_002_0	9	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					.16	5.00		15.00					.16	5.00		15.00																		10.00				.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	9	5	Specialty Tier	3	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													637.27	33		33					637.27	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	9	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.22	7.00		21.00					.06	2.00		6.00					.06	2.00		6.00																		7.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	9	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					.16	5.00		15.00					.16	5.00		15.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	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					.96	30.00		90.00					.96	30.00		90.00																		35.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	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					2.41	75.00		225.00					2.41	75.00		225.00																		80.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	9	5	Specialty Tier	1	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													637.27	33		33					637.27	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	9	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.22	7.00		21.00					.06	2.00		6.00					.06	2.00		6.00																		7.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5435	024	0	1	09	04	H5435_024_0	3	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					686.00	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	3	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							275.00				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	3	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5439	001	0	1	04	01	H5439_001_0	2	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	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	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	2	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	001	0	1	04	01	H5439_001_0	2	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	2	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.83	25.00	50.00	75.00					0.67	20.00	40.00	60.00												0.83	25.00	50.00	75.00				0.67	20.00	40.00	40.00				25.00				0.73	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	2	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					0.17	5.00	10.00	15.00												0.33	10.00	20.00	30.00				0.17	5.00	10.00	10.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	2	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00												0.17	5.00	10.00	15.00				0.00	0.00	0.00	0.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	2	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	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	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	2	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	2	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.50	15.00	30.00	45.00												0.67	20.00	40.00	60.00				0.50	15.00	30.00	30.00				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	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	2	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	245.00				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	2	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	95.00				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	2	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.50	15.00	30.00	45.00												0.67	20.00	40.00	60.00				0.50	15.00	30.00	30.00				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	2	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.17	5.00	10.00	15.00					0.00	0.00	0.00	0.00												0.17	5.00	10.00	15.00				0.00	0.00	0.00	0.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	007	0	1	04	01	H5439_007_0	2	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	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5441	001	0	1	48	05	H5441_001_0	7	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				1			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			
H5441	001	0	1	48	05	H5441_001_0	7	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		01			1	30													30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H5441	001	0	1	48	05	H5441_001_0	7	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				1			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			
H5471	001	0	1	01	01	H5471_001_0	10	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		3
H5471	001	0	1	01	01	H5471_001_0	10	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	10	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	10	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	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																								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	10	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	10	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	8	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		3
H5471	002	0	1	01	01	H5471_002_0	8	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	.50	15.00																																												15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.07	2.00		6.00																								6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	8	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	8	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	8	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												
H5471	002	0	1	01	01	H5471_002_0	8	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	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																								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	8	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	8	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		3
H5471	004	0	1	01	01	H5471_004_0	8	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	8	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	8	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	8	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	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	007	0	1	01	01	H5471_007_0	7	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	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		3
H5471	007	0	1	01	01	H5471_007_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	007	0	1	01	01	H5471_007_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	007	0	1	01	01	H5471_007_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	007	0	1	01	01	H5471_007_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	008	0	1	01	01	H5471_008_0	9	1	Preferred Generic	1	4	001000	1	2	110		01			1	30		90				2							30		31	.17	5.00		15.00																																										5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01			1	30		90				2							30		31	.33	10.00		30.00																																										10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	9	2	Non-Preferred Generic	3	4	000100	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										1		
H5471	008	0	1	01	01	H5471_008_0	9	3	Preferred Brand	1	4	000001	1	2	110		01			1	30		90				2							30		31	.50	15.00		45.00																																										15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	9	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	1.17	35.00																																												35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	9	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	9	1	Preferred Generic	3	4	001000	1	2	110		01			1	30		90				2							30		31	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		
H5471	009	0	1	01	01	H5471_009_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01			1	30		90				2							30		31	.33	10.00		30.00																																										10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	9	3	Preferred Brand	1	4	000001	1	2	110		01			1	30		90				2							30		31	.50	15.00		45.00																																										15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	9	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	1.17	35.00																																												35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	9	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	9	1	Preferred Generic	3	4	001000	3	2	110		01			1	30		90				2							30		31	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		3
H5471	009	0	1	01	01	H5471_009_0	9	2	Non-Preferred Generic	3	4	000100	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										1		
H5471	009	0	1	01	01	H5471_009_0	9	1	Preferred Generic	1	4	001000	3	2	110		01			1	30		90				2							30		31	.17	5.00		15.00																																										5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	9	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	012	0	1	01	01	H5471_012_0	9	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	9	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		3
H5471	012	0	1	01	01	H5471_012_0	9	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	9	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	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.17	5.00		15.00																								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	9	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	9	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	9	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	020	0	1	01	01	H5471_020_0	8	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	8	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	8	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		3
H5471	020	0	1	01	01	H5471_020_0	8	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	8	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	8	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	020	0	1	01	01	H5471_020_0	8	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	8	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	8	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	021	0	1	01	01	H5471_021_0	8	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	8	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	8	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	8	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	8	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	8	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		3
H5471	021	0	1	01	01	H5471_021_0	8	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	8	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	022	0	1	01	01	H5471_022_0	8	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	8	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	8	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	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																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	002	0	1	01	01	H5475_002_0	6	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	6	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	6	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												
H5475	002	0	1	01	01	H5475_002_0	6	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	6	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												
H5507	001	0	1	04	01	H5507_001_0	2	5	Specialty Tier	1	3	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												
H5507	001	0	1	04	01	H5507_001_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5507	001	0	1	04	01	H5507_001_0	2	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							125.00				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	2	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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5507	001	0	1	04	01	H5507_001_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	001	0	1	04	01	H5508_001_0	14	1	Generic	3	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	001	0	1	04	01	H5508_001_0	14	1	Generic	1	4	010000	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	001	0	1	04	01	H5508_001_0	14	5	Select Care Drugs	1	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	.08	2.50		7.50																					.08	2.50		5.00																		2.50				.07	2.50		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	001	0	1	04	01	H5508_001_0	14	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	001	0	1	04	01	H5508_001_0	14	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	001	0	1	04	01	H5508_001_0	14	2	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	001	0	1	04	01	H5508_001_0	14	5	Select Care Drugs	3	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	.08	2.50		7.50																					.08	2.50		5.00																		2.50				.08	2.50		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	005	0	1	04	01	H5508_005_0	15	1	Generic	1	4	010000	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	005	0	1	04	01	H5508_005_0	15	5	Select Care Drugs	3	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	.08	2.50		7.50																					.08	2.50		5.00																		2.50				.08	2.50		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	005	0	1	04	01	H5508_005_0	15	1	Generic	3	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	005	0	1	04	01	H5508_005_0	15	5	Select Care Drugs	1	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	.08	2.50		7.50																					.08	2.50		5.00																		2.50				.07	2.50		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	005	0	1	04	01	H5508_005_0	15	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	005	0	1	04	01	H5508_005_0	15	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	005	0	1	04	01	H5508_005_0	15	2	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	006	0	1	04	01	H5508_006_0	13	1	Generic	3	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	006	0	1	04	01	H5508_006_0	13	5	Select Care Drugs	1	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	.08	2.50		7.50																					.08	2.50		5.00																		2.50				.07	2.50		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	006	0	1	04	01	H5508_006_0	13	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	006	0	1	04	01	H5508_006_0	13	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	006	0	1	04	01	H5508_006_0	13	2	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	006	0	1	04	01	H5508_006_0	13	1	Generic	1	4	010000	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	006	0	1	04	01	H5508_006_0	13	5	Select Care Drugs	3	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	.08	2.50		7.50																					.08	2.50		5.00																		2.50				.08	2.50		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5509	001	0	1	04	01	H5509_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	30.00					.23	7.00	14.00	21.00					.23	7.00	14.00	21.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	001	0	1	04	01	H5509_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.73	22.00	44.00	66.00					.56	17.00	34.00	51.00					.56	17.00	34.00	51.00																			22.00			.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	001	0	1	04	01	H5509_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	001	0	1	04	01	H5509_001_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													42.76	50	50	50					39.45	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	001	0	1	04	01	H5509_001_0	7	3	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	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												
H5509	003	0	1	04	01	H5509_003_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.66	20.00	40.00	60.00					.50	15.00	30.00	45.00					.50	15.00	30.00	45.00																			20.00			.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	003	0	1	04	01	H5509_003_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	20.00					.23	7.00	14.00	14.00					.23	7.00	14.00	14.00																			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	4	3	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	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												
H5509	003	0	1	04	01	H5509_003_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													40.39	50	50	50					39.74	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	003	0	1	04	01	H5509_003_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	010	0	1	04	01	H5509_010_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	25.00					.16	5.00	10.00	12.50					.16	5.00	10.00	12.50																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	010	0	1	04	01	H5509_010_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.66	20.00	40.00	60.00					.50	15.00	30.00	45.00					.50	15.00	30.00	45.00																			20.00			.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	010	0	1	04	01	H5509_010_0	6	3	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	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												
H5509	010	0	1	04	01	H5509_010_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													68.10	50	50	50					68.21	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	010	0	1	04	01	H5509_010_0	6	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							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	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.66	20.00	40.00	60.00					.50	15.00	30.00	45.00					.50	15.00	30.00	45.00																			20.00			.64	20.00		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	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	30.00					.20	6.00	12.00	18.00					.20	6.00	12.00	18.00																			10.00			.32	10.00		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	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		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	10	010		1				30				30							10	31													1.00	33							1.00	33							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	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													45.83	50	50	50					44.67	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	012	0	1	04	01	H5509_012_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					.00	0.00	0.00	0.00					.00	0.00	0.00	0.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	012	0	1	04	01	H5509_012_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.50	15.00	30.00	45.00					.33	10.00	20.00	30.00					.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	012	0	1	04	01	H5509_012_0	4	3	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	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												
H5509	012	0	1	04	01	H5509_012_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													37.57	50	50	50					33.60	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	012	0	1	04	01	H5509_012_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							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	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	0.00					.20	6.00	12.00	0.00					.20	6.00	12.00	0.00																			10.00			.32	10.00		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	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													38.20	50	50	50					34.32	50	50	50					50	50	50																		50			50	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	10	111		1				30	60	90	1	30	60	90					10	31									.50	15.00	30.00	45.00					.33	10.00	20.00	30.00					.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	3	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	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												
H5509	016	0	1	04	01	H5509_016_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	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	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		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	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													40.40	50	50	50					38.85	50	50	50					50	50	50																		50			50	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	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	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	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	20.00					.20	6.00	12.00	12.00					.20	6.00	12.00	12.00																			10.00			.32	10.00		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	10	111		1				30	60	90	1	30	60	90					10	31									.66	20.00	40.00	40.00					.50	15.00	30.00	30.00					.50	15.00	30.00	30.00																			20.00			.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	018	0	1	04	01	H5509_018_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	10.00					.20	6.00	12.00	6.00					.20	6.00	12.00	6.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	018	0	1	04	01	H5509_018_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.73	22.00	44.00	66.00					.56	17.00	34.00	51.00					.56	17.00	34.00	51.00																			22.00			.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	018	0	1	04	01	H5509_018_0	5	3	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	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												
H5509	018	0	1	04	01	H5509_018_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													58.70	50	50	50					56.38	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	018	0	1	04	01	H5509_018_0	5	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							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	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	10.00					.00	0.00	0.00	0.00					.00	0.00	0.00	0.00																			5.00			.16	5.00		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	10	111		1				30	60	90	1	30	60	90					10	31									.50	15.00	30.00	45.00					.33	10.00	20.00	30.00					.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	019	0	1	04	01	H5509_019_0	7	3	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	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												
H5509	019	0	1	04	01	H5509_019_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													57.09	50	50	50					54.75	50	50	50					50	50	50																		50			50	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	10	010		1				30				30							10	31													1.00	33							1.00	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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					726.00	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5516	001	0	1	04	01	H5516_001_0	2	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							275.00				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	2	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							125.00				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	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5520	002	0	1	04	01	H5520_002_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.33	10.00	20.00	30.00												0.67	20.00	40.00	60.00				0.33	10.00	20.00	20.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	2	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					0.17	5.00	10.00	15.00												0.33	10.00	20.00	30.00				0.17	5.00	10.00	10.00				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	2	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	70.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	2	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	213.00				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	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	2	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	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	2	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					0.17	5.00	10.00	15.00												0.33	10.00	20.00	30.00				0.17	5.00	10.00	10.00				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	2	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.33	10.00	20.00	30.00												0.67	20.00	40.00	60.00				0.33	10.00	20.00	20.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	2	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	70.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	2	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	213.00				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	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	2	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	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	2	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.50	15.00	30.00	45.00												0.67	20.00	40.00	60.00				0.50	15.00	30.00	30.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	2	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					0.17	5.00	10.00	15.00												0.33	10.00	20.00	30.00				0.17	5.00	10.00	10.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	2	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	70.00				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	2	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	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	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	2	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	213.00				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	2	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					0.17	5.00	10.00	15.00												0.33	10.00	20.00	30.00				0.17	5.00	10.00	10.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	2	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.50	15.00	30.00	45.00												0.67	20.00	40.00	60.00				0.50	15.00	30.00	30.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	2	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	70.00				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	2	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	213.00				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	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	2	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	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	3	1	04	01	H5520_012_3	2	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					0.17	5.00	10.00	15.00												0.33	10.00	20.00	30.00				0.17	5.00	10.00	10.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	2	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.50	15.00	30.00	45.00												0.67	20.00	40.00	60.00				0.50	15.00	30.00	30.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	2	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	213.00				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	2	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	70.00				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	2	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	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	2	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	213.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	014	0	1	04	01	H5520_014_0	2	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	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	2	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					0.17	5.00	10.00	15.00												0.33	10.00	20.00	30.00				0.17	5.00	10.00	10.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.83	25.00	50.00	75.00					0.67	20.00	40.00	60.00												0.83	25.00	50.00	75.00				0.67	20.00	40.00	40.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	2	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	70.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	2	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	213.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	2	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	70.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	2	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.50	15.00	30.00	45.00												0.67	20.00	40.00	60.00				0.50	15.00	30.00	30.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	2	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					0.17	5.00	10.00	15.00												0.33	10.00	20.00	30.00				0.17	5.00	10.00	10.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	015	1	1	04	01	H5520_015_1	2	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	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	2	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	213.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	2	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	70.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	2	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.67	20.00	40.00	60.00					0.50	15.00	30.00	45.00												0.67	20.00	40.00	60.00				0.50	15.00	30.00	30.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	2	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					0.17	5.00	10.00	15.00												0.33	10.00	20.00	30.00				0.17	5.00	10.00	10.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	015	2	1	04	01	H5520_015_2	2	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	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	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					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												
H5521	012	0	1	04	01	H5521_012_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.66	20.00	40.00	60.00					0.50	15.00	30.00	45.00												0.66	20.00	40.00	60.00				0.50	15.00	30.00	45.00					20.00			0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	012	0	1	04	01	H5521_012_0	5	3	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	135.00												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												
H5521	012	0	1	04	01	H5521_012_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													44.75	50	50	50					39.19	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	012	0	1	04	01	H5521_012_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.26	8.00	16.00	24.00					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												
H5521	013	0	1	04	01	H5521_013_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.53	16.00	32.00	48.00					0.40	12.00	24.00	36.00												0.53	16.00	32.00	48.00				0.40	12.00	24.00	36.00					16.00			0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	5	3	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	135.00												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												
H5521	013	0	1	04	01	H5521_013_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													46.93	50	50	50					44.50	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	10	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.56	17.00	34.00	51.00					0.43	13.00	26.00	39.00												0.56	17.00	34.00	51.00				0.43	13.00	26.00	39.00					17.00			0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	10	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	10	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.26	50	50	50					38.97	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	10	3	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	135.00												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												
H5521	015	0	1	04	01	H5521_015_0	10	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	4	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					44.50	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	4	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	4	2	Non-Preferred Generic	1	4	000100	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	30.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	4	1	Preferred Generic	1	4	001000	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												
H5521	016	0	1	04	01	H5521_016_0	4	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	4	1	Preferred Generic	3	4	001000	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										1		
H5521	020	0	1	04	01	H5521_020_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													27.17	50	50	50					25.04	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	5	3	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	135.00												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												
H5521	020	0	1	04	01	H5521_020_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.30	9.00	18.00	27.00					.16	5.00	10.00	15.00												.30	9.00	18.00	27.00				.16	5.00	10.00	15.00					9.00			.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	5	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	022	0	1	04	01	H5521_022_0	7	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.46	14.00	28.00	42.00					.33	10.00	20.00	30.00												.46	14.00	28.00	42.00				.33	10.00	20.00	30.00					14.00			.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	7	3	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	135.00												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												
H5521	022	0	1	04	01	H5521_022_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													43.78	50	50	50					41.02	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	7	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	4	3	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	135.00												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												
H5521	027	0	1	04	01	H5521_027_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.46	14.00	28.00	42.00					0.26	8.00	16.00	24.00												0.46	14.00	28.00	42.00				0.26	8.00	16.00	24.00					14.00			0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00												0.33	10.00	20.00	30.00				0.16	5.00	10.00	15.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.34	50	50	50					54.89	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	028	0	1	04	01	H5521_028_0	11	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.23	7.00	14.00	21.00					.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												
H5521	028	0	1	04	01	H5521_028_0	11	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.50	15.00	30.00	45.00					.36	11.00	22.00	33.00												.50	15.00	30.00	45.00				.36	11.00	22.00	33.00					15.00			.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	028	0	1	04	01	H5521_028_0	11	3	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	135.00												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												
H5521	028	0	1	04	01	H5521_028_0	11	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													43.33	50	50	50					35.74	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	028	0	1	04	01	H5521_028_0	11	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	5	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	5	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					46.64	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	5	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	5	1	Preferred Generic	1	4	001000	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												
H5521	033	0	1	04	01	H5521_033_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	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												
H5521	037	0	1	04	01	H5521_037_0	7	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	12.00					0.00	0.00	0.00	0.00												0.20	6.00	12.00	12.00				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												
H5521	037	0	1	04	01	H5521_037_0	7	3	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	135.00												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												
H5521	037	0	1	04	01	H5521_037_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													55.35	50	50	50					52.98	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	7	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.46	14.00	28.00	28.00					0.26	8.00	16.00	16.00												0.46	14.00	28.00	28.00				0.26	8.00	16.00	16.00					14.00			0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													61.88	50	50	50					61.05	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	7	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	7	3	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	135.00												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												
H5521	040	0	1	04	01	H5521_040_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.46	14.00	28.00	28.00					0.26	8.00	16.00	16.00												0.46	14.00	28.00	28.00				0.26	8.00	16.00	16.00					14.00			0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	7	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	12.00					0.00	0.00	0.00	0.00												0.20	6.00	12.00	12.00				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												
H5521	052	0	1	04	01	H5521_052_0	6	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	052	0	1	04	01	H5521_052_0	6	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	10.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	052	0	1	04	01	H5521_052_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.23	7.00	14.00	17.50					.10	3.00	6.00	7.50												.23	7.00	14.00	17.50				.10	3.00	6.00	7.50					7.00			.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	052	0	1	04	01	H5521_052_0	6	3	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	112.50					1.50	45.00	90.00	112.50												1.50	45.00	90.00	112.50				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												
H5521	052	0	1	04	01	H5521_052_0	6	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	10.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	052	0	1	04	01	H5521_052_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													40.97	50	50	50					38.78	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													40.00	50	50	50					37.80	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	053	0	1	04	01	H5521_053_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	053	0	1	04	01	H5521_053_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.26	8.00	16.00	24.00					.13	4.00	8.00	12.00												.26	8.00	16.00	24.00				.13	4.00	8.00	12.00					8.00			.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	053	0	1	04	01	H5521_053_0	4	3	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	135.00												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												
H5521	055	0	1	04	01	H5521_055_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	055	0	1	04	01	H5521_055_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.26	8.00	16.00	24.00					.13	4.00	8.00	12.00												.26	8.00	16.00	24.00				.13	4.00	8.00	12.00					8.00			.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	055	0	1	04	01	H5521_055_0	4	3	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	135.00												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												
H5521	055	0	1	04	01	H5521_055_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													46.77	50	50	50					44.49	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	056	0	1	04	01	H5521_056_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	056	0	1	04	01	H5521_056_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.33	10.00	20.00	30.00					.20	6.00	12.00	18.00												.33	10.00	20.00	30.00				.20	6.00	12.00	18.00					10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	056	0	1	04	01	H5521_056_0	4	3	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	135.00												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												
H5521	056	0	1	04	01	H5521_056_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													38.50	50	50	50					36.43	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	057	0	1	04	01	H5521_057_0	8	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					39.43	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	057	0	1	04	01	H5521_057_0	8	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	057	0	1	04	01	H5521_057_0	8	2	Non-Preferred Generic	1	4	000100	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	24.00																			8.00			.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	057	0	1	04	01	H5521_057_0	8	1	Preferred Generic	1	4	001000	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												
H5521	058	0	1	04	01	H5521_058_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	058	0	1	04	01	H5521_058_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.30	9.00	18.00	27.00					.16	5.00	10.00	15.00												.30	9.00	18.00	27.00				.16	5.00	10.00	15.00					9.00			.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	058	0	1	04	01	H5521_058_0	4	3	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	135.00												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												
H5521	058	0	1	04	01	H5521_058_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													40.92	50	50	50					38.74	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	059	0	1	04	01	H5521_059_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	059	0	1	04	01	H5521_059_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													41.29	50	50	50					39.08	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	059	0	1	04	01	H5521_059_0	5	3	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	135.00												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												
H5521	059	0	1	04	01	H5521_059_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.30	9.00	18.00	27.00					.16	5.00	10.00	15.00												.30	9.00	18.00	27.00				.16	5.00	10.00	15.00					9.00			.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	060	0	1	04	01	H5521_060_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	060	0	1	04	01	H5521_060_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													40.68	50	50	50					38.51	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	060	0	1	04	01	H5521_060_0	4	3	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	135.00												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												
H5521	060	0	1	04	01	H5521_060_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.30	9.00	18.00	27.00					.16	5.00	10.00	15.00												.30	9.00	18.00	27.00				.16	5.00	10.00	15.00					9.00			.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	076	0	1	04	01	H5521_076_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.30	9.00	18.00	18.00					0.16	5.00	10.00	10.00												0.30	9.00	18.00	18.00				0.16	5.00	10.00	10.00					9.00			0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.46	14.00	28.00	28.00					0.33	10.00	20.00	20.00												0.46	14.00	28.00	28.00				0.33	10.00	20.00	20.00					14.00			0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	4	3	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	135.00												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												
H5521	076	0	1	04	01	H5521_076_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													42.29	50	50	50					39.97	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.20	6.00	12.00	12.00					0.00	0.00	0.00	0.00												0.20	6.00	12.00	12.00				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												
H5521	077	0	1	04	01	H5521_077_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.46	14.00	28.00	28.00					0.26	8.00	16.00	16.00												0.46	14.00	28.00	28.00				0.26	8.00	16.00	16.00					14.00			0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	5	3	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	135.00												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												
H5521	077	0	1	04	01	H5521_077_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													42.62	50	50	50					39.84	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	3	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00	16.00	24.00				0.06	2.00	4.00	6.00					8.00			0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.80	24.00	48.00	72.00					0.60	18.00	36.00	54.00												0.80	24.00	48.00	72.00				0.60	18.00	36.00	54.00					24.00			0.77	24.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	3	3	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	135.00												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												
H5521	081	0	1	04	01	H5521_081_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													46.59	50	50	50					43.11	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	3	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	3	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					35.63	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	3	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.46	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												
H5521	082	0	1	04	01	H5521_082_0	3	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					10	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												
H5521	082	0	1	04	01	H5521_082_0	3	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	3	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	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												
H5521	083	0	1	04	01	H5521_083_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.46	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												
H5521	083	0	1	04	01	H5521_083_0	3	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	3	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					34.99	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	3	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	3	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.26	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.26	8.00	16.00	24.00				0.10	3.00	6.00	9.00					8.00			0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.56	17.00	34.00	51.00					0.40	12.00	24.00	36.00												0.56	17.00	34.00	51.00				0.40	12.00	24.00	36.00					17.00			0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	3	3	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	135.00												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												
H5521	084	0	1	04	01	H5521_084_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													36.26	50	50	50					33.69	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	3	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													38.72	50	50	50					36.65	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	5	3	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	135.00												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												
H5521	085	0	1	04	01	H5521_085_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.46	14.00	28.00	42.00					.33	10.00	20.00	30.00												.46	14.00	28.00	42.00				.33	10.00	20.00	30.00					14.00			.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	5	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	086	0	1	04	01	H5521_086_0	3	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.12	50	50	50					36.86	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	3	3	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	135.00												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												
H5521	086	0	1	04	01	H5521_086_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.23	7.00	14.00	21.00					.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												
H5521	086	0	1	04	01	H5521_086_0	3	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	3	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	087	0	1	04	01	H5521_087_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.23	50	50	50					37.04	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	4	3	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	135.00												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												
H5521	087	0	1	04	01	H5521_087_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.46	14.00	28.00	42.00					.33	10.00	20.00	30.00												.46	14.00	28.00	42.00				.33	10.00	20.00	30.00					14.00			.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	4	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	088	0	1	04	01	H5521_088_0	4	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	088	0	1	04	01	H5521_088_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.23	50	50	50					37.04	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	4	3	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	135.00												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												
H5521	088	0	1	04	01	H5521_088_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.46	14.00	28.00	42.00					.33	10.00	20.00	30.00												.46	14.00	28.00	42.00				.33	10.00	20.00	30.00					14.00			.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	4	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	089	0	1	04	01	H5521_089_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.23	50	50	50					37.04	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	4	3	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	135.00												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												
H5521	089	0	1	04	01	H5521_089_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.46	14.00	28.00	42.00					.33	10.00	20.00	30.00												.46	14.00	28.00	42.00				.33	10.00	20.00	30.00					14.00			.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.46	14.00	28.00	42.00					.33	10.00	20.00	30.00												.46	14.00	28.00	42.00				.33	10.00	20.00	30.00					14.00			.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	4	3	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	135.00												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												
H5521	090	0	1	04	01	H5521_090_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.23	50	50	50					37.04	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	4	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	091	0	1	04	01	H5521_091_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00	20.00	30.00				0.13	4.00	8.00	12.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.86	26.00	52.00	78.00					0.66	20.00	40.00	60.00												0.86	26.00	52.00	78.00				0.66	20.00	40.00	60.00					26.00			0.83	26.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													51.57	50	50	50					50.18	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	3	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	135.00												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												
H5521	092	0	1	04	01	H5521_092_0	5	3	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	135.00												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												
H5521	092	0	1	04	01	H5521_092_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.43	13.00	26.00	39.00					.30	9.00	18.00	27.00												.43	13.00	26.00	39.00				.30	9.00	18.00	27.00					13.00			.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	092	0	1	04	01	H5521_092_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.20	6.00	12.00	18.00					.06	2.00	4.00	6.00												.20	6.00	12.00	18.00				.06	2.00	4.00	6.00					6.00			.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	092	0	1	04	01	H5521_092_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													44.49	50	50	50					40.60	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	093	0	1	04	01	H5521_093_0	6	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.20	6.00	12.00	18.00					.06	2.00	4.00	6.00												.20	6.00	12.00	18.00				.06	2.00	4.00	6.00					6.00			.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	093	0	1	04	01	H5521_093_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.33	10.00	20.00	30.00					.20	6.00	12.00	18.00												.33	10.00	20.00	30.00				.20	6.00	12.00	18.00					10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	093	0	1	04	01	H5521_093_0	6	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	093	0	1	04	01	H5521_093_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													57.64	50	50	50					54.28	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	093	0	1	04	01	H5521_093_0	6	3	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	135.00												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												
H5521	094	0	1	04	01	H5521_094_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.30	9.00	18.00	27.00					.16	5.00	10.00	15.00												.30	9.00	18.00	27.00				.16	5.00	10.00	15.00					9.00			.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	094	0	1	04	01	H5521_094_0	7	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	094	0	1	04	01	H5521_094_0	7	3	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	135.00												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												
H5521	094	0	1	04	01	H5521_094_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													61.10	50	50	50					60.84	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5521	095	0	1	04	01	H5521_095_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.66	20.00	40.00	60.00					0.46	14.00	28.00	42.00												0.66	20.00	40.00	60.00				0.46	14.00	28.00	42.00					20.00			0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.30	9.00	18.00	27.00					0.10	3.00	6.00	9.00												0.30	9.00	18.00	27.00				0.10	3.00	6.00	9.00					9.00			0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	5	3	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	135.00												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												
H5521	095	0	1	04	01	H5521_095_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													46.75	50	50	50					43.71	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_0	5	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	8.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	8.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													42.05	50	50	50					39.71	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.40	12.00	24.00	24.00					0.26	8.00	16.00	16.00												0.40	12.00	24.00	24.00				0.26	8.00	16.00	16.00					12.00			0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_0	5	3	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	135.00												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												
H5521	098	0	1	04	01	H5521_098_0	5	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							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	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	25.00					.16	5.00	10.00	12.50					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												
H5522	001	0	1	04	01	H5522_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.60	18.00	36.00	45.00					0.26	8.00	16.00	20.00					0.26	8.00	16.00	20.00																			18.00			0.58	18.00		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	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	25.00					.16	5.00	10.00	12.50					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		
H5522	001	0	1	04	01	H5522_001_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													56.73	50	50	50					52.31	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							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	3	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	112.50					1.50	45.00	90.00	112.50					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												
H5522	002	0	1	04	01	H5522_002_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.26	8.00	16.00	20.00					0.06	2.00	4.00	5.00					0.06	2.00	4.00	5.00																			8.00			0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.60	18.00	36.00	45.00					0.26	8.00	16.00	20.00					0.26	8.00	16.00	20.00																			18.00			0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	4	3	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	112.50					1.50	45.00	90.00	112.50					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												
H5522	002	0	1	04	01	H5522_002_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													55.47	50	50	50					52.40	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	4	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.26	8.00	16.00	20.00					0.06	2.00	4.00	5.00					0.06	2.00	4.00	5.00																			8.00			0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5522	004	0	1	04	01	H5522_004_0	3	3	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	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												
H5522	004	0	1	04	01	H5522_004_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.76	23.00	46.00	69.00					0.43	13.00	26.00	39.00					0.43	13.00	26.00	39.00																			23.00			0.74	23.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.23	7.00	14.00	21.00					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												
H5522	004	0	1	04	01	H5522_004_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													57.41	50	50	50					54.10	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	4	3	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	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												
H5522	005	0	1	04	01	H5522_005_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	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	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.53	16.00	32.00	48.00					0.20	6.00	12.00	18.00					0.20	6.00	12.00	18.00																			16.00			0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													60.05	50	50	50					55.56	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													58.59	50	50	50					56.15	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	3	3	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	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												
H5522	013	0	1	04	01	H5522_013_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.63	19.00	38.00	57.00					0.30	9.00	18.00	27.00					0.30	9.00	18.00	27.00																			19.00			0.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.23	7.00	14.00	21.00					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												
H5522	014	0	1	04	01	H5522_014_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.63	19.00	38.00	57.00					0.30	9.00	18.00	27.00					0.30	9.00	18.00	27.00																			19.00			0.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.20	6.00	12.00	18.00					0.20	6.00	12.00	18.00																			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	4	3	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	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												
H5522	014	0	1	04	01	H5522_014_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													62.16	50	50	50					62.94	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	015	0	1	04	01	H5522_015_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.83	25.00	50.00	75.00					0.50	15.00	30.00	45.00					0.50	15.00	30.00	45.00																			25.00			0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	015	0	1	04	01	H5522_015_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.23	7.00	14.00	21.00					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												
H5522	015	0	1	04	01	H5522_015_0	4	3	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	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												
H5522	015	0	1	04	01	H5522_015_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													57.30	50	50	50					54.38	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	015	0	1	04	01	H5522_015_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.96	29.00	58.00	87.00					0.63	19.00	38.00	57.00					0.63	19.00	38.00	57.00																			29.00			0.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.26	8.00	16.00	24.00					0.26	8.00	16.00	24.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	2	3	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	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												
H5522	017	0	1	04	01	H5522_017_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													55.18	50	50	50					52.75	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.26	8.00	16.00	24.00					0.26	8.00	16.00	24.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.96	29.00	58.00	87.00					0.63	19.00	38.00	57.00					0.63	19.00	38.00	57.00																			29.00			0.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	3	3	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	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												
H5522	018	0	1	04	01	H5522_018_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													52.09	50	50	50					49.70	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	3	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	15.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5525	004	0	1	04	01	H5525_004_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		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										2	3	
H5525	004	0	1	04	01	H5525_004_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		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										2	3	
H5525	004	0	1	04	01	H5525_004_0	3	5	Specialty Tier	3	4	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										2	3	
H5525	004	0	1	04	01	H5525_004_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		18.00				0.20	6.00		0.00				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	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		45.00				0.50	15.00		0.00				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	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		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												
H5525	004	0	1	04	01	H5525_004_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		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												
H5525	004	0	1	04	01	H5525_004_0	3	5	Specialty Tier	1	4	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												
H5525	004	0	1	04	01	H5525_004_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	004	0	1	04	01	H5525_004_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	005	0	1	04	01	H5525_005_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		21.00				0.23	7.00		0.00				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	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		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										2	3	
H5525	005	0	1	04	01	H5525_005_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		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										2	3	
H5525	005	0	1	04	01	H5525_005_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		54.00				0.60	18.00		0.00				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	3	5	Specialty Tier	3	4	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										2	3	
H5525	005	0	1	04	01	H5525_005_0	3	5	Specialty Tier	1	4	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												
H5525	005	0	1	04	01	H5525_005_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		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												
H5525	005	0	1	04	01	H5525_005_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		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												
H5525	005	0	1	04	01	H5525_005_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		54.00				0.60	18.00		0.00				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	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	006	0	1	04	01	H5525_006_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		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										2	3	
H5525	006	0	1	04	01	H5525_006_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		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										2	3	
H5525	006	0	1	04	01	H5525_006_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	006	0	1	04	01	H5525_006_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	006	0	1	04	01	H5525_006_0	3	5	Specialty Tier	1	4	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												
H5525	006	0	1	04	01	H5525_006_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		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												
H5525	006	0	1	04	01	H5525_006_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		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												
H5525	006	0	1	04	01	H5525_006_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_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		18.00				0.20	6.00		0.00				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	3	5	Specialty Tier	3	4	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										2	3	
H5525	007	0	1	04	01	H5525_007_0	3	5	Specialty Tier	3	4	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										2	3	
H5525	007	0	1	04	01	H5525_007_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		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										2	3	
H5525	007	0	1	04	01	H5525_007_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	007	0	1	04	01	H5525_007_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	3	5	Specialty Tier	1	4	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												
H5525	007	0	1	04	01	H5525_007_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		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												
H5525	007	0	1	04	01	H5525_007_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		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												
H5525	007	0	1	04	01	H5525_007_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		54.00				0.60	18.00		0.00				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	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		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										2	3	
H5525	008	0	1	04	01	H5525_008_0	3	5	Specialty Tier	3	4	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										2	3	
H5525	008	0	1	04	01	H5525_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		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										2	3	
H5525	008	0	1	04	01	H5525_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		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										2	3	
H5525	008	0	1	04	01	H5525_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	008	0	1	04	01	H5525_008_0	3	5	Specialty Tier	1	4	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												
H5525	008	0	1	04	01	H5525_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		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												
H5525	008	0	1	04	01	H5525_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		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												
H5525	008	0	1	04	01	H5525_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	008	0	1	04	01	H5525_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	008	0	1	04	01	H5525_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	009	0	1	04	01	H5525_009_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	009	0	1	04	01	H5525_009_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		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												
H5525	009	0	1	04	01	H5525_009_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		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												
H5525	009	0	1	04	01	H5525_009_0	3	5	Specialty Tier	1	4	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												
H5525	009	0	1	04	01	H5525_009_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	009	0	1	04	01	H5525_009_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	009	0	1	04	01	H5525_009_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		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										2	3	
H5525	009	0	1	04	01	H5525_009_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		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										2	3	
H5525	009	0	1	04	01	H5525_009_0	3	5	Specialty Tier	3	4	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										2	3	
H5525	009	0	1	04	01	H5525_009_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	015	0	1	04	01	H5525_015_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	3	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		33.00				0.36	11.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	3	5	Specialty Tier	3	4	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										2	3	
H5525	015	0	1	04	01	H5525_015_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		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										2	3	
H5525	015	0	1	04	01	H5525_015_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		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										2	3	
H5525	015	0	1	04	01	H5525_015_0	3	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		33.00				0.36	11.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	015	0	1	04	01	H5525_015_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	015	0	1	04	01	H5525_015_0	3	5	Specialty Tier	1	4	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												
H5525	015	0	1	04	01	H5525_015_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		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												
H5525	015	0	1	04	01	H5525_015_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		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												
H5525	017	0	1	04	01	H5525_017_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_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		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										2	3	
H5525	017	0	1	04	01	H5525_017_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		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										2	3	
H5525	017	0	1	04	01	H5525_017_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	017	0	1	04	01	H5525_017_0	3	5	Specialty Tier	3	4	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										2	3	
H5525	017	0	1	04	01	H5525_017_0	3	5	Specialty Tier	1	4	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												
H5525	017	0	1	04	01	H5525_017_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		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												
H5525	017	0	1	04	01	H5525_017_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		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												
H5525	017	0	1	04	01	H5525_017_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	020	0	1	04	01	H5525_020_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	020	0	1	04	01	H5525_020_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		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										2	3	
H5525	020	0	1	04	01	H5525_020_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	020	0	1	04	01	H5525_020_0	3	5	Specialty Tier	1	4	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												
H5525	020	0	1	04	01	H5525_020_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		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												
H5525	020	0	1	04	01	H5525_020_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		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												
H5525	020	0	1	04	01	H5525_020_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	3	5	Specialty Tier	3	4	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										2	3	
H5525	020	0	1	04	01	H5525_020_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		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										2	3	
H5525	021	0	1	04	01	H5525_021_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	021	0	1	04	01	H5525_021_0	5	5	Specialty Tier	1	4	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												
H5525	021	0	1	04	01	H5525_021_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		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										2	3	
H5525	021	0	1	04	01	H5525_021_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		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												
H5525	021	0	1	04	01	H5525_021_0	5	5	Specialty Tier	3	4	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										2	3	
H5525	021	0	1	04	01	H5525_021_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	021	0	1	04	01	H5525_021_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	021	0	1	04	01	H5525_021_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		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										2	3	
H5525	021	0	1	04	01	H5525_021_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	021	0	1	04	01	H5525_021_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		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												
H5525	022	0	1	04	01	H5525_022_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		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												
H5525	022	0	1	04	01	H5525_022_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_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		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												
H5525	022	0	1	04	01	H5525_022_0	5	5	Specialty Tier	1	4	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												
H5525	022	0	1	04	01	H5525_022_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	022	0	1	04	01	H5525_022_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	022	0	1	04	01	H5525_022_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		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										2	3	
H5525	022	0	1	04	01	H5525_022_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		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										2	3	
H5525	022	0	1	04	01	H5525_022_0	5	5	Specialty Tier	3	4	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										2	3	
H5525	023	0	1	04	01	H5525_023_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	023	0	1	04	01	H5525_023_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	023	0	1	04	01	H5525_023_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		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										2	3	
H5525	023	0	1	04	01	H5525_023_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		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										2	3	
H5525	023	0	1	04	01	H5525_023_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	5	5	Specialty Tier	1	4	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												
H5525	023	0	1	04	01	H5525_023_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		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												
H5525	023	0	1	04	01	H5525_023_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		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												
H5525	023	0	1	04	01	H5525_023_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	5	5	Specialty Tier	3	4	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										2	3	
H5525	024	0	1	04	01	H5525_024_0	4	5	Specialty Tier	1	4	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												
H5525	024	0	1	04	01	H5525_024_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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	024	0	1	04	01	H5525_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		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										2	3	
H5525	024	0	1	04	01	H5525_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		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										2	3	
H5525	024	0	1	04	01	H5525_024_0	4	5	Specialty Tier	3	4	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										2	3	
H5525	024	0	1	04	01	H5525_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	024	0	1	04	01	H5525_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		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												
H5525	024	0	1	04	01	H5525_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		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												
H5525	024	0	1	04	01	H5525_024_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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	024	0	1	04	01	H5525_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	025	0	1	04	01	H5525_025_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	025	0	1	04	01	H5525_025_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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	025	0	1	04	01	H5525_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		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										2	3	
H5525	025	0	1	04	01	H5525_025_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		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										2	3	
H5525	025	0	1	04	01	H5525_025_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	025	0	1	04	01	H5525_025_0	4	5	Specialty Tier	1	4	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												
H5525	025	0	1	04	01	H5525_025_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		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												
H5525	025	0	1	04	01	H5525_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		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												
H5525	025	0	1	04	01	H5525_025_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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	025	0	1	04	01	H5525_025_0	4	5	Specialty Tier	3	4	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										2	3	
H5525	026	0	1	04	01	H5525_026_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		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										2	3	
H5525	026	0	1	04	01	H5525_026_0	4	5	Specialty Tier	3	4	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										2	3	
H5525	026	0	1	04	01	H5525_026_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		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										2	3	
H5525	026	0	1	04	01	H5525_026_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	026	0	1	04	01	H5525_026_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	026	0	1	04	01	H5525_026_0	4	5	Specialty Tier	1	4	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												
H5525	026	0	1	04	01	H5525_026_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		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												
H5525	026	0	1	04	01	H5525_026_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		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												
H5525	026	0	1	04	01	H5525_026_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	3	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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_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		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												
H5525	027	0	1	04	01	H5525_027_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		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												
H5525	027	0	1	04	01	H5525_027_0	3	5	Specialty Tier	1	3	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												
H5525	027	0	1	04	01	H5525_027_0	3	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	029	0	1	04	01	H5525_029_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	029	0	1	04	01	H5525_029_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	029	0	1	04	01	H5525_029_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		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										2	3	
H5525	029	0	1	04	01	H5525_029_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		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										2	3	
H5525	029	0	1	04	01	H5525_029_0	3	5	Specialty Tier	1	4	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												
H5525	029	0	1	04	01	H5525_029_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		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												
H5525	029	0	1	04	01	H5525_029_0	3	5	Specialty Tier	3	4	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										2	3	
H5525	029	0	1	04	01	H5525_029_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	029	0	1	04	01	H5525_029_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	029	0	1	04	01	H5525_029_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		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												
H5526	004	0	1	04	01	H5526_004_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		10	110		1	30		90				2	30		90					29	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												
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	1.50	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												
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	0.17	5.00		15.00																					0.17	5.00		12.50																			5.00			0.16	5.00		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	0.50	15.00		45.00																					0.50	15.00		37.50																			15.00			0.48	15.00		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					34.00	33		33																					33		33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	014	0	1	04	01	H5526_014_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		10	110		1	30		90				2	30		90					29	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												
H5526	014	0	1	04	01	H5526_014_0	6	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	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												
H5526	014	0	1	04	01	H5526_014_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.50	15.00		45.00																					0.50	15.00		37.50																			15.00			0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	014	0	1	04	01	H5526_014_0	6	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	0.17	5.00		15.00																					0.17	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	6	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					34.00	33		33																					33		33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	7	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	0.23	7.00		21.00																					0.23	7.00		17.50																			7.00			0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.67	20.00		60.00																					0.67	20.00		50.00																			20.00			0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	7	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	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												
H5526	016	0	1	04	01	H5526_016_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		10	110		1	30		90				2	30		90					29	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												
H5526	016	0	1	04	01	H5526_016_0	7	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					34.00	33		33																					33		33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	017	0	1	04	01	H5526_017_0	8	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	0.23	7.00		21.00																					0.23	7.00		17.50																			7.00			0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	017	0	1	04	01	H5526_017_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.67	20.00		60.00																					0.67	20.00		50.00																			20.00			0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	017	0	1	04	01	H5526_017_0	8	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	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												
H5526	017	0	1	04	01	H5526_017_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		10	110		1	30		90				2	30		90					29	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												
H5526	017	0	1	04	01	H5526_017_0	8	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					34.00	33		33																					33		33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	018	0	1	04	01	H5528_018_0	8	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	8	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.30	9.00	18.00	27.00																					0.30	9.00	18.00	27.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	018	0	1	04	01	H5528_018_0	8	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					319.61	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	8	4	Non-Preferred Brand	1	2	100000	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					65.51	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	8	3	Preferred Brand	1	2	000001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					53.15	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	022	0	1	04	01	H5528_022_0	5	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												
H5528	022	0	1	04	01	H5528_022_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	022	0	1	04	01	H5528_022_0	5	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																					1.33	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	022	0	1	04	01	H5528_022_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	022	0	1	04	01	H5528_022_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					684.90	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	023	0	1	04	01	H5528_023_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					731.52	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	023	0	1	04	01	H5528_023_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	023	0	1	04	01	H5528_023_0	5	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												
H5528	023	0	1	04	01	H5528_023_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	023	0	1	04	01	H5528_023_0	5	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																					1.33	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	024	0	1	04	01	H5528_024_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					726.02	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	024	0	1	04	01	H5528_024_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	024	0	1	04	01	H5528_024_0	5	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																					1.33	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	024	0	1	04	01	H5528_024_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	024	0	1	04	01	H5528_024_0	5	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												
H5528	025	0	1	04	01	H5528_025_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	025	0	1	04	01	H5528_025_0	5	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																					1.33	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	025	0	1	04	01	H5528_025_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	025	0	1	04	01	H5528_025_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					834.06	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	025	0	1	04	01	H5528_025_0	5	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												
H5528	026	0	1	04	01	H5528_026_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	026	0	1	04	01	H5528_026_0	5	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																					1.33	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	026	0	1	04	01	H5528_026_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	026	0	1	04	01	H5528_026_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					319.61	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	026	0	1	04	01	H5528_026_0	5	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												
H5529	008	1	1	04	01	H5529_008_1	12	6	Select Care Drugs	1	3	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												
H5529	008	1	1	04	01	H5529_008_1	12	5	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, Specialty Tier, Select Care Drugs												
H5529	008	1	1	04	01	H5529_008_1	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	008	1	1	04	01	H5529_008_1	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	008	1	1	04	01	H5529_008_1	12	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.76	23.00	46.00	69.00					0.60	18.00	36.00	54.00					0.60	18.00	36.00	36.00																		23.00				0.67	23.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	008	1	1	04	01	H5529_008_1	12	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	008	2	1	04	01	H5529_008_2	13	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	008	2	1	04	01	H5529_008_2	13	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.76	23.00	46.00	69.00					0.60	18.00	36.00	54.00					0.60	18.00	36.00	36.00																		23.00				0.67	23.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	008	2	1	04	01	H5529_008_2	13	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	008	2	1	04	01	H5529_008_2	13	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	008	2	1	04	01	H5529_008_2	13	5	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, Specialty Tier, Select Care Drugs												
H5529	008	2	1	04	01	H5529_008_2	13	6	Select Care Drugs	1	3	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												
H5529	009	1	1	04	01	H5529_009_1	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	009	1	1	04	01	H5529_009_1	12	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	009	1	1	04	01	H5529_009_1	12	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.83	25.00	50.00	75.00					0.66	20.00	40.00	60.00					0.66	20.00	40.00	40.00																		25.00				0.73	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	009	1	1	04	01	H5529_009_1	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	009	1	1	04	01	H5529_009_1	12	6	Select Care Drugs	1	3	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												
H5529	009	1	1	04	01	H5529_009_1	12	5	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, Specialty Tier, Select Care Drugs												
H5529	009	2	1	04	01	H5529_009_2	12	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	009	2	1	04	01	H5529_009_2	12	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.83	25.00	50.00	75.00					0.66	20.00	40.00	60.00					0.66	20.00	40.00	40.00																		25.00				0.73	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	009	2	1	04	01	H5529_009_2	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	009	2	1	04	01	H5529_009_2	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5529	009	2	1	04	01	H5529_009_2	12	5	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, Specialty Tier, Select Care Drugs												
H5529	009	2	1	04	01	H5529_009_2	12	6	Select Care Drugs	1	3	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												
H5530	006	1	1	04	01	H5530_006_1	14	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	14	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.63	19.00	38.00	57.00					.46	14.00	28.00	42.00					.46	14.00	28.00	28.00																		19.00				.55	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	14	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	14	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	14	5	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, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	14	6	Select Care Drugs	1	3	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												
H5530	006	2	1	04	01	H5530_006_2	14	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	14	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.63	19.00	38.00	57.00					.46	14.00	28.00	42.00					.46	14.00	28.00	28.00																		19.00				.55	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	14	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	14	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	14	5	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, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	14	6	Select Care Drugs	1	3	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												
H5532	001	0	1	04	01	H5532_001_0	2	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							125.00				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	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5532	001	0	1	04	01	H5532_001_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5532	001	0	1	04	01	H5532_001_0	2	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							275.00				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	2	5	Specialty Tier	1	3	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												
H5533	003	0	1	04	01	H5533_003_0	5	2	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	5	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	.33	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	5	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	5	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					912.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	5	5	Select Care Drugs	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, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	5	2	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	5	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	5	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	5	5	Select Care Drugs	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, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	5	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					912.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	006	0	1	04	01	H5533_006_0	6	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	.33	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	6	2	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	006	0	1	04	01	H5533_006_0	6	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					912.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	006	0	1	04	01	H5533_006_0	6	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	006	0	1	04	01	H5533_006_0	6	5	Select Care Drugs	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, 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	.30	9.00		27.00																								27.00																		9.00				.29	9.00		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	33		33																							33																	33				33	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	3.17	95.00		285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	012	0	1	02	01	H5576_012_0	10	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	.09	3.00		9.00																															9.00							0.00				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	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	.25	8.00		24.00																															24.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	012	0	1	02	01	H5576_012_0	10	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31					1250.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	012	0	1	02	01	H5576_012_0	10	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																															285.00							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	10	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	1.45	45.00		135.00																															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	1	1	02	01	H5576_016_1	12	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	.25	8.00		24.00																															24.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	016	1	1	02	01	H5576_016_1	12	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31					1650.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	1	1	02	01	H5576_016_1	12	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	.09	3.00		9.00																															9.00							0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	016	1	1	02	01	H5576_016_1	12	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																															285.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	1	1	02	01	H5576_016_1	12	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	1.45	45.00		135.00																															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	1	1	02	01	H5576_016_1	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	.25	8.00		24.00																															24.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	1	1	02	01	H5576_016_1	12	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	.09	3.00		9.00																															9.00							0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	2	1	02	01	H5576_016_2	12	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																															285.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	2	1	02	01	H5576_016_2	12	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31					1650.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	2	1	02	01	H5576_016_2	12	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	.09	3.00		9.00																															9.00							0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	016	2	1	02	01	H5576_016_2	12	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	.25	8.00		24.00																															24.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	016	2	1	02	01	H5576_016_2	12	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	.09	3.00		9.00																															9.00							0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	2	1	02	01	H5576_016_2	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	.25	8.00		24.00																															24.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	2	1	02	01	H5576_016_2	12	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	1.45	45.00		135.00																															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	13	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																															285.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	13	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31					1250.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	13	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	.09	3.00		9.00																															9.00							0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	.25	8.00		24.00																															24.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	13	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	1.45	45.00		135.00																															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	11	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	.25	8.00		24.00																															24.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	11	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	1.45	45.00		135.00																															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	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																															285.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	11	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31					1250.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	11	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	.09	3.00		9.00																															9.00							0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	12	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31					1650.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	12	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																															285.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	12	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	1.45	45.00		135.00																															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	12	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	.09	3.00		9.00																															9.00							0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	018	1	1	02	01	H5576_018_1	12	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	.09	3.00		9.00																															9.00							0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	.25	8.00		24.00																															24.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	12	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	.09	3.00		9.00																															9.00							0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	018	2	1	02	01	H5576_018_2	12	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31					1650.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	12	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																															285.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	12	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	1.45	45.00		135.00																															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	.25	8.00		24.00																															24.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	12	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	.09	3.00		9.00																															9.00							0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	10	1	Generic	1	4	010000	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	10	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.17	35.00		105.00																					1.17	35.00		70.00																		35.00				1.13	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	10	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	1.83	55.00		165.00																					1.83	55.00		110.00																		55.00				1.77	55.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	10	4	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31					856.92	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	10	1	Generic	3	4	010000	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5577	008	0	1	02	01	H5577_008_0	10	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	30							30						30		31					856.92	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	10	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												
H5577	008	0	1	02	01	H5577_008_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.37	41.00		123.00																					1.37	41.00		82.00																		41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	008	0	1	02	01	H5577_008_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	1.97	59.00		177.00																					1.97	59.00		118.00																		59.00				1.90	59.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	008	0	1	02	01	H5577_008_0	10	2	Non-Preferred Generic	3	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										1		
H5577	008	0	1	02	01	H5577_008_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.20	6.00		18.00																					0.20	6.00		12.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5577	008	0	1	02	01	H5577_008_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.20	6.00		18.00																					0.20	6.00		12.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	7	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					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	7	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.20	6.00	12.00	18.00					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	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	001	0	1	02	01	H5591_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	270.00					3.17	95.00	190.00	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	7	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					1.33	40.00	80.00	120.00					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	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									3.17	95.00	190.00	285.00					3.00	90.00	180.00	270.00					3.17	95.00	190.00	237.50																		95.00				3.06	95.00		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	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					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									0.33	10.00	20.00	30.00					0.20	6.00	12.00	18.00					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	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					1.33	40.00	80.00	120.00					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	006	1	1	02	01	H5591_006_1	7	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					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	006	1	1	02	01	H5591_006_1	7	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.20	6.00	12.00	18.00					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	006	1	1	02	01	H5591_006_1	7	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					1.33	40.00	80.00	120.00					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	006	1	1	02	01	H5591_006_1	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	270.00					3.17	95.00	190.00	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	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	006	2	1	02	01	H5591_006_2	6	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					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	006	2	1	02	01	H5591_006_2	6	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.20	6.00	12.00	18.00					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	006	2	1	02	01	H5591_006_2	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					1.33	40.00	80.00	120.00					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	006	2	1	02	01	H5591_006_2	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	270.00					3.17	95.00	190.00	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	6	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												
H5594	001	0	1	02	01	H5594_001_0	8	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	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	001	0	1	02	01	H5594_001_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	001	0	1	02	01	H5594_001_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																					.96	30.00		60.00																		30.00				.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	002	0	1	02	01	H5594_002_0	8	2	Preferred Brand	1	4	000101	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		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	002	0	1	02	01	H5594_002_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	002	0	1	02	01	H5594_002_0	8	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	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		3
H5594	002	0	1	02	01	H5594_002_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	016	0	1	01	01	H5594_016_0	8	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		135.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	8	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						25		25																					25		25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	8	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		285.00																		95.00				3.06	95.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_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	017	0	1	01	01	H5594_017_0	8	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						25		25																					25		25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	8	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		285.00																		95.00				3.06	95.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_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	017	0	1	01	01	H5594_017_0	8	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		135.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	019	0	1	02	01	H5594_019_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		3
H5594	019	0	1	02	01	H5594_019_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	019	0	1	02	01	H5594_019_0	8	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	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				.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	019	0	1	02	01	H5594_019_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	022	0	1	02	01	H5594_022_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		3
H5594	022	0	1	02	01	H5594_022_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	022	0	1	02	01	H5594_022_0	8	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	022	0	1	02	01	H5594_022_0	8	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	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	026	0	1	02	01	H5594_026_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		3
H5594	026	0	1	02	01	H5594_026_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	026	0	1	02	01	H5594_026_0	8	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	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	026	0	1	02	01	H5594_026_0	8	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	028	0	1	02	01	H5594_028_0	8	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	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	028	0	1	02	01	H5594_028_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	028	0	1	02	01	H5594_028_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		3
H5594	028	0	1	02	01	H5594_028_0	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	.66	20.00		60.00																					.66	20.00		40.00																		20.00				.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	029	0	1	02	01	H5594_029_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		3
H5594	029	0	1	02	01	H5594_029_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	029	0	1	02	01	H5594_029_0	8	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	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	.83	25.00		75.00																					.83	25.00		50.00																		25.00				.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	029	0	1	02	01	H5594_029_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	030	0	1	02	01	H5594_030_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		3
H5594	030	0	1	02	01	H5594_030_0	8	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	030	0	1	02	01	H5594_030_0	8	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	030	0	1	02	01	H5594_030_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	030	0	1	02	01	H5594_030_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	9	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		3
H5594	031	0	1	02	01	H5594_031_0	9	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	9	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	031	0	1	02	01	H5594_031_0	9	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	031	0	1	02	01	H5594_031_0	9	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	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		3
H5594	032	0	1	02	01	H5594_032_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	032	0	1	02	01	H5594_032_0	8	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	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	.83	25.00		75.00																					.83	25.00		50.00																		25.00				.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	032	0	1	02	01	H5594_032_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												
H5608	002	0	1	01	01	H5608_002_0	11	5	Specialty Tier	1	3	000010	1	1	111		10	100		1	31	60	90				1			90					10	31					216.15	26	26	26																							26																		26			26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5608	002	0	1	01	01	H5608_002_0	11	1	Preferred Generic	1	3	001000	1	2	111		10	100		1	31	60	90				1			90					10	31	0.09	3.00	6.00	6.00																								6.00																			3.00			.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5608	002	0	1	01	01	H5608_002_0	11	2	Non-Preferred Generic	1	3	000100	1	2	111		10	100		1	31	60	90				1			90					10	31	0.19	6.00	12.00	12.00																								12.00																			6.00			.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5608	002	0	1	01	01	H5608_002_0	11	3	Preferred Brand	1	3	000001	1	1	111		10	100		1	31	60	90				1			90					10	31					22.45	25	25	25																							25																		25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5608	002	0	1	01	01	H5608_002_0	11	4	Non-Preferred Brand	1	3	100000	1	1	111		10	100		1	31	60	90				1			90					10	31					83.21	50	50	50																							50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.14	5.00		15.00																								15.00																		5.00				0.14	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	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1530.28	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	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.44	15.00		45.00																								45.00																		15.00				0.48	15.00		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	0.14	5.00		15.00																								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	3	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	3	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.44	15.00		45.00																								45.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	3	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1614.87	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	3	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.14	5.00		15.00																								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	3	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	3	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.14	5.00		15.00																								15.00																		5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	001	0	1	01	01	H5619_001_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		54.00				0.60	18.00		0.00				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	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	3	5	Specialty Tier	3	4	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										2	3	
H5619	001	0	1	01	01	H5619_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		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										2	3	
H5619	001	0	1	01	01	H5619_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		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										2	3	
H5619	001	0	1	01	01	H5619_001_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		54.00				0.60	18.00		0.00				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	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		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												
H5619	001	0	1	01	01	H5619_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		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												
H5619	001	0	1	01	01	H5619_001_0	3	5	Specialty Tier	1	4	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												
H5619	001	0	1	01	01	H5619_001_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	003	0	1	01	01	H5619_003_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		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												
H5619	003	0	1	01	01	H5619_003_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		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												
H5619	003	0	1	01	01	H5619_003_0	6	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		33.00				0.36	11.00		0.00				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	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												
H5619	003	0	1	01	01	H5619_003_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	007	0	1	01	01	H5619_007_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		54.00				0.60	18.00		0.00				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	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	007	0	1	01	01	H5619_007_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		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												
H5619	007	0	1	01	01	H5619_007_0	3	5	Specialty Tier	3	4	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										2	3	
H5619	007	0	1	01	01	H5619_007_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		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										2	3	
H5619	007	0	1	01	01	H5619_007_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		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										2	3	
H5619	007	0	1	01	01	H5619_007_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		54.00				0.60	18.00		0.00				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	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	007	0	1	01	01	H5619_007_0	3	5	Specialty Tier	1	4	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												
H5619	007	0	1	01	01	H5619_007_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		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												
H5619	009	0	1	01	01	H5619_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		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												
H5619	009	0	1	01	01	H5619_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		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												
H5619	009	0	1	01	01	H5619_009_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	009	0	1	01	01	H5619_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		33.00				0.36	11.00		0.00				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	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	011	0	1	01	01	H5619_011_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												
H5619	011	0	1	01	01	H5619_011_0	3	5	Specialty Tier	1	3	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												
H5619	011	0	1	01	01	H5619_011_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		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												
H5619	011	0	1	01	01	H5619_011_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		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												
H5619	011	0	1	01	01	H5619_011_0	3	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	001	0	1	01	01	H5628_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												
H5628	001	0	1	01	01	H5628_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												
H5628	001	0	1	01	01	H5628_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												
H5628	001	0	1	01	01	H5628_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												
H5628	007	0	1	01	01	H5628_007_0	6	1	Generic	1	4	010000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.19	6.00	12.00	18.00																					0.19	6.00	12.00	18.00																		6.00				0.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	6	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												
H5628	007	0	1	01	01	H5628_007_0	6	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	007	0	1	01	01	H5628_007_0	6	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												
H5649	001	0	1	01	01	H5649_001_0	7	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			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, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	7	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																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	7	3	Preferred Brand	1	4	000001	3	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, Select Care Drugs												
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, Select Care Drugs												
H5649	001	0	1	01	01	H5649_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, Select Care Drugs												
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, Select Care Drugs										1		
H5649	001	0	1	01	01	H5649_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, Select Care Drugs										1		
H5649	001	0	1	01	01	H5649_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					343.53	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	002	0	1	01	01	H5649_002_0	8	6	Select Care Drugs	1	4	000010	1	1	110		01	100		1	30		90				1			90				30		31					3.27	15		15																							15																	15				15	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	8	3	Preferred Brand	1	4	000001	3	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, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	8	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					561.02	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_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												
H5649	002	0	1	01	01	H5649_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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	8	4	Non-Preferred Brand	1	4	100000	1	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, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_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		
H5649	004	0	1	01	01	H5649_004_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					457.37	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_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, Select Care Drugs										1		1
H5649	004	0	1	01	01	H5649_004_0	7	6	Select Care Drugs	1	4	000010	1	1	110		01	100		1	30		90				1			90				30		31					3.26	15		15																							15																	15				15	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_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, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	7	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												
H5649	004	0	1	01	01	H5649_004_0	7	4	Non-Preferred Brand	1	4	100000	1	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, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	7	3	Preferred Brand	1	4	000001	3	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, Select Care Drugs												
H5649	005	0	1	01	01	H5649_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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	005	0	1	01	01	H5649_005_0	5	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, Select Care Drugs										1		
H5649	005	0	1	01	01	H5649_005_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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	005	0	1	01	01	H5649_005_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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	005	0	1	01	01	H5649_005_0	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					343.53	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	005	0	1	01	01	H5649_005_0	5	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																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	005	0	1	01	01	H5649_005_0	5	3	Preferred Brand	1	4	000001	3	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, Select Care Drugs												
H5649	005	0	1	01	01	H5649_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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	005	0	1	01	01	H5649_005_0	5	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, Select Care Drugs												
H5652	001	0	1	02	01	H5652_001_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																															15.00							10.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	4	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																															30.00							20.00				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	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																															135.00							125.00				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	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																															255.00							245.00				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	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					476.00	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	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												
H5652	003	0	1	02	01	H5652_003_0	4	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																															12.00							8.00				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	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.06	32.00		96.00																															96.00							86.00				32.00				1.03	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_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																															210.00							200.00				70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					188.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	004	0	1	02	01	H5652_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												
H5652	004	0	1	02	01	H5652_004_0	4	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																															30.00							20.00				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	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																															135.00							125.00				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	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																															255.00							245.00				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	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												
H5652	006	0	1	02	01	H5652_006_0	3	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																															30.00							20.00				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	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															15.00							10.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					455.00	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	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																															255.00							245.00				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	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	7	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		5.00				.07	2.00		2.00				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	7	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		17.50				.23	7.00		7.00				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	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												
H5656	001	0	1	01	01	H5656_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		200.00				2.67	80.00		80.00				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	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		100.00				1.33	40.00		40.00				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	7	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		100.00				1.33	40.00		40.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5656	001	0	1	01	01	H5656_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		5.00				.07	2.00		2.00				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	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		17.50				.23	7.00		7.00				7.00				.21	7.00		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												
H5698	028	0	1	01	01	H5698_028_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.26	8.00		24.00					.10	3.00		9.00												.26	8.00		24.00				.10	3.00		0.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	028	0	1	01	01	H5698_028_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.66	20.00		60.00					.40	12.00		36.00												.66	20.00		60.00				.40	12.00		30.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	028	0	1	01	01	H5698_028_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														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	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	6	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	6	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														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	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.73	22.00		66.00					.50	15.00		45.00												.73	22.00		66.00				.50	15.00		37.50				22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	062	0	1	01	01	H5698_062_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					.13	4.00		12.00												.30	9.00		27.00				.13	4.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														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	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.26	8.00		24.00					.10	3.00		9.00												.26	8.00		24.00				.10	3.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.66	20.00		60.00					.43	13.00		39.00												.66	20.00		60.00				.43	13.00		32.50				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_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		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	128	0	1	01	01	H5698_128_0	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	128	0	1	01	01	H5698_128_0	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.53	76.00		228.00												3.16	95.00		285.00				2.53	76.00		190.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	128	0	1	01	01	H5698_128_0	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	128	0	1	01	01	H5698_128_0	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.46	14.00		42.00					.06	2.00		6.00												.46	14.00		42.00				.06	2.00		5.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	128	0	1	01	01	H5698_128_0	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					.83	25.00		75.00												1.50	45.00		135.00				.83	25.00		62.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	134	0	1	01	01	H5698_134_0	7	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	134	0	1	01	01	H5698_134_0	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.80	84.00		252.00												3.16	95.00		285.00				2.80	84.00		210.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	134	0	1	01	01	H5698_134_0	7	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	134	0	1	01	01	H5698_134_0	7	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.13	34.00		102.00												1.50	45.00		135.00				1.13	34.00		85.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	134	0	1	01	01	H5698_134_0	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.46	14.00		42.00					.06	2.00		6.00												.46	14.00		42.00				.06	2.00		5.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	140	0	1	01	01	H5698_140_0	6	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.66	80.00		240.00												3.16	95.00		285.00				2.66	80.00		200.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	140	0	1	01	01	H5698_140_0	6	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.00	30.00		90.00												1.50	45.00		135.00				1.00	30.00		75.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	140	0	1	01	01	H5698_140_0	6	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.46	14.00		42.00					.06	2.00		6.00												.46	14.00		42.00				.06	2.00		5.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	140	0	1	01	01	H5698_140_0	6	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	140	0	1	01	01	H5698_140_0	6	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	158	0	1	01	01	H5698_158_0	6	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	158	0	1	01	01	H5698_158_0	6	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.70	81.00		243.00												3.16	95.00		285.00				2.70	81.00		202.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	158	0	1	01	01	H5698_158_0	6	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.00	30.00		90.00												1.50	45.00		135.00				1.00	30.00		75.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	158	0	1	01	01	H5698_158_0	6	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.46	14.00		42.00					.06	2.00		6.00												.46	14.00		42.00				.06	2.00		5.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	158	0	1	01	01	H5698_158_0	6	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	159	0	1	01	01	H5698_159_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		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.73	22.00		66.00					0.46	14.00		42.00												.73	22.00		66.00				0.46	14.00		35.00				22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	159	0	1	01	01	H5698_159_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.03	1.00		3.00												.30	9.00		27.00				0.03	1.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	159	0	1	01	01	H5698_159_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														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	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	198	0	1	02	01	H5698_198_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	198	0	1	02	01	H5698_198_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		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	198	0	1	02	01	H5698_198_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									1.00	30.00		90.00					0.50	15.00		45.00												1.00	30.00		90.00				0.50	15.00		37.50				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	198	0	1	02	01	H5698_198_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					.16	5.00		15.00												.33	10.00		30.00				.16	5.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	198	0	1	02	01	H5698_198_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	199	0	1	02	01	H5698_199_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	199	0	1	02	01	H5698_199_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	199	0	1	02	01	H5698_199_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		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	199	0	1	02	01	H5698_199_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									1.00	30.00		90.00					0.33	10.00		30.00												1.00	30.00		90.00				0.33	10.00		25.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	199	0	1	02	01	H5698_199_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					.10	3.00		9.00												.33	10.00		30.00				.10	3.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	200	0	1	01	01	H5698_200_0	6	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.56	77.00		231.00												3.16	95.00		285.00				2.56	77.00		192.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	200	0	1	01	01	H5698_200_0	6	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					.90	27.00		81.00												1.50	45.00		135.00				.90	27.00		67.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	200	0	1	01	01	H5698_200_0	6	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.46	14.00		42.00					.06	2.00		6.00												.46	14.00		42.00				.06	2.00		5.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	200	0	1	01	01	H5698_200_0	6	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	200	0	1	01	01	H5698_200_0	6	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5746	015	1	1	01	01	H5746_015_1	9	6	Select Care Drugs	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												
H5746	015	1	1	01	01	H5746_015_1	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5746	015	1	1	01	01	H5746_015_1	9	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.63	19.00	38.00	57.00					0.46	14.00	28.00	42.00					0.46	14.00	28.00	28.00																		19.00				.55	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5746	015	1	1	01	01	H5746_015_1	9	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5746	015	1	1	01	01	H5746_015_1	9	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5746	015	1	1	01	01	H5746_015_1	9	5	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, Specialty Tier, Select Care Drugs												
H5746	015	2	1	01	01	H5746_015_2	9	5	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, Specialty Tier, Select Care Drugs												
H5746	015	2	1	01	01	H5746_015_2	9	6	Select Care Drugs	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												
H5746	015	2	1	01	01	H5746_015_2	9	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5746	015	2	1	01	01	H5746_015_2	9	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5746	015	2	1	01	01	H5746_015_2	9	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.63	19.00	38.00	57.00					0.46	14.00	28.00	42.00					0.46	14.00	28.00	28.00																		19.00				.55	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5746	015	2	1	01	01	H5746_015_2	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5749	001	0	1	02	01	H5749_001_0	3	5	Specialty Tier	1	3	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												
H5749	001	0	1	02	01	H5749_001_0	3	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							275.00				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	3	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							125.00				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	3	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																															24.00							16.00				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	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					.33	10.00		30.00								20.00																		33.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	005	0	1	01	01	H5774_005_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.16	5.00		15.00								10.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	005	0	1	01	01	H5774_005_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.16	5.00		15.00								10.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					.33	10.00		30.00								20.00																		33.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		135.00					1.16	35.00		105.00								70.00																		45.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_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					1.66	50.00		150.00								100.00																		75.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	9	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31													33.00	33		33					33.00	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	10	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31													33.00	33		33					33.00	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	10	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					.50	15.00		45.00								30.00																		33.00				.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	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.20	6.00		18.00								12.00																		10.00				.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	10	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					1.66	50.00		150.00								100.00																		95.00				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	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		135.00					1.33	40.00		120.00								80.00																		45.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	008	0	1	01	01	H5774_008_0	10	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					.50	15.00		45.00								30.00																		33.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	008	0	1	01	01	H5774_008_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.20	6.00		18.00								12.00																		10.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	009	0	1	01	01	H5774_009_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					.33	10.00		30.00								20.00																		33.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	009	0	1	01	01	H5774_009_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.16	5.00		15.00								10.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	009	0	1	01	01	H5774_009_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		135.00					1.16	35.00		105.00								70.00																		45.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	009	0	1	01	01	H5774_009_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					1.66	50.00		150.00								100.00																		75.00				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	9	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31													33.00	33		33					33.00	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	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.16	5.00		15.00								10.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	009	0	1	01	01	H5774_009_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					.33	10.00		30.00								20.00																		33.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	019	0	1	01	01	H5774_019_0	10	1	Preferred Generic	1	2	001000	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.10	3.00		9.00								6.00																		10.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	019	0	1	01	01	H5774_019_0	10	2	Non-Preferred Generic	1	2	000100	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					.33	10.00		30.00								20.00																		33.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	019	0	1	01	01	H5774_019_0	10	3	Preferred Brand	1	2	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		135.00					1.16	35.00		105.00								70.00																		45.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	019	0	1	01	01	H5774_019_0	10	4	Non-Preferred Brand	1	2	100000	1	2		110	01	100		1				30		90	1			90				30		31									3.17	95.00		285.00					1.66	50.00		150.00								100.00																		95.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	019	0	1	01	01	H5774_019_0	10	5	Specialty Tier	1	2	100100	1	1		110	01	100		1				30		90	1			90				30		31													15.00	25		25					15.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	022	0	1	01	01	H5774_022_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					.33	10.00		30.00								20.00																		33.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	022	0	1	01	01	H5774_022_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.16	5.00		15.00								10.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	022	0	1	01	01	H5774_022_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		135.00					1.16	35.00		105.00								70.00																		45.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	022	0	1	01	01	H5774_022_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					.33	10.00		30.00								20.00																		33.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	022	0	1	01	01	H5774_022_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.16	5.00		15.00								10.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	022	0	1	01	01	H5774_022_0	8	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31													33.00	33		33					33.00	33		33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	022	0	1	01	01	H5774_022_0	8	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					1.66	50.00		150.00								100.00																		75.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	6	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	6	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	6	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	6	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												
H5779	002	0	1	01	01	H5779_002_0	6	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	6	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	6	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	6	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	6	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	6	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	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.26	8.00	16.00	24.00					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												
H5793	001	0	1	01	01	H5793_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.53	16.00	32.00	48.00					0.40	12.00	24.00	36.00												0.53	16.00	32.00	48.00				0.40	12.00	24.00	36.00					16.00			0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	4	3	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	135.00												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												
H5793	001	0	1	01	01	H5793_001_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													45.32	50	50	50					42.61	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	008	0	1	01	01	H5793_008_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.26	8.00	16.00	24.00					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												
H5793	008	0	1	01	01	H5793_008_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.53	16.00	32.00	48.00					0.40	12.00	24.00	36.00												0.53	16.00	32.00	48.00				0.40	12.00	24.00	36.00					16.00			0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	008	0	1	01	01	H5793_008_0	4	3	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	135.00												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												
H5793	008	0	1	01	01	H5793_008_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													48.46	50	50	50					45.30	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	008	0	1	01	01	H5793_008_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	010	0	1	01	01	H5793_010_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.26	8.00	16.00	24.00					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												
H5793	010	0	1	01	01	H5793_010_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.53	16.00	32.00	48.00					0.40	12.00	24.00	36.00												0.53	16.00	32.00	48.00				0.40	12.00	24.00	36.00					16.00			0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	010	0	1	01	01	H5793_010_0	4	3	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	135.00												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												
H5793	010	0	1	01	01	H5793_010_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													43.92	50	50	50					41.16	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	010	0	1	01	01	H5793_010_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	001	0	1	01	01	H5810_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												
H5810	001	0	1	01	01	H5810_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												
H5810	001	0	1	01	01	H5810_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												
H5810	001	0	1	01	01	H5810_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												
H5813	003	0	1	01	01	H5813_003_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													44.41	50	50	50					40.82	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5813	003	0	1	01	01	H5813_003_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5813	003	0	1	01	01	H5813_003_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.36	11.00	22.00	33.00					0.23	7.00	14.00	21.00												0.36	11.00	22.00	33.00				0.23	7.00	14.00	21.00					11.00			0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5813	003	0	1	01	01	H5813_003_0	4	3	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	135.00												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												
H5813	003	0	1	01	01	H5813_003_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5813	006	0	1	01	01	H5813_006_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.36	11.00	22.00	33.00					0.23	7.00	14.00	21.00												0.36	11.00	22.00	33.00				0.23	7.00	14.00	21.00					11.00			0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5813	006	0	1	01	01	H5813_006_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5813	006	0	1	01	01	H5813_006_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													47.40	50	50	50					45.34	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5813	006	0	1	01	01	H5813_006_0	4	3	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	135.00												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												
H5813	006	0	1	01	01	H5813_006_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5817	009	0	1	01	01	H5817_009_0	8	2	Non-Preferred Generic	3	4	000100	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		
H5817	009	0	1	01	01	H5817_009_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	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	009	0	1	01	01	H5817_009_0	8	2	Non-Preferred Generic	1	4	000100	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												
H5817	009	0	1	01	01	H5817_009_0	8	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	135.00					1.50	45.00	135.00	135.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	009	0	1	01	01	H5817_009_0	8	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		
H5817	009	0	1	01	01	H5817_009_0	8	5	Specialty Tier	1	4	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, Specialty Tier, Select Care Drugs												
H5817	009	0	1	01	01	H5817_009_0	8	6	Select Care Drugs	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		
H5817	009	0	1	01	01	H5817_009_0	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	009	0	1	01	01	H5817_009_0	8	6	Select Care Drugs	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												
H5817	018	0	1	01	01	H5817_018_0	8	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	018	0	1	01	01	H5817_018_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.43	13.00	26.00	39.00					.26	8.00	16.00	24.00					.26	8.00	16.00	16.00																		13.00				.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	018	0	1	01	01	H5817_018_0	8	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					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		7.00				.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	018	0	1	01	01	H5817_018_0	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	018	0	1	01	01	H5817_018_0	8	6	Select Care Drugs	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												
H5817	018	0	1	01	01	H5817_018_0	8	5	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, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	8	5	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, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	8	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.43	13.00	26.00	39.00					.26	8.00	16.00	24.00					.26	8.00	16.00	16.00																		13.00				.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	8	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					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		7.00				.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	8	6	Select Care Drugs	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												
H5817	020	1	1	01	01	H5817_020_1	8	5	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, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	8	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.63	19.00	38.00	57.00					0.46	14.00	28.00	42.00					0.46	14.00	28.00	28.00																		19.00				.55	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	8	6	Select Care Drugs	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												
H5817	020	2	1	01	01	H5817_020_2	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.63	19.00	38.00	57.00					0.46	14.00	28.00	42.00					0.46	14.00	28.00	28.00																		19.00				.55	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	8	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	8	5	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, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	8	6	Select Care Drugs	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												
H5817	020	3	1	01	01	H5817_020_3	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.63	19.00	38.00	57.00					0.46	14.00	28.00	42.00					0.46	14.00	28.00	28.00																		19.00				.55	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	8	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	8	5	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, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	8	6	Select Care Drugs	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												
H5817	020	4	1	01	01	H5817_020_4	8	6	Select Care Drugs	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												
H5817	020	4	1	01	01	H5817_020_4	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	4	1	01	01	H5817_020_4	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.63	19.00	38.00	57.00					0.46	14.00	28.00	42.00					0.46	14.00	28.00	28.00																		19.00				.55	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	4	1	01	01	H5817_020_4	8	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	4	1	01	01	H5817_020_4	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	4	1	01	01	H5817_020_4	8	5	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, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.63	19.00	38.00	57.00					0.46	14.00	28.00	42.00					0.46	14.00	28.00	28.00																		19.00				.55	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	8	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	8	5	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, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	8	6	Select Care Drugs	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												
H5817	020	6	1	01	01	H5817_020_6	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.63	19.00	38.00	57.00					0.46	14.00	28.00	42.00					0.46	14.00	28.00	28.00																		19.00				.55	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	8	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	8	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	8	5	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, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	8	6	Select Care Drugs	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												
H5826	008	0	1	01	01	H5826_008_0	15	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	15	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	15	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	12	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	12	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	12	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	15	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	15	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	15	3	Specialty Tier	1	4	010010	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	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5832	001	0	1	01	01	H5832_001_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5832	001	0	1	01	01	H5832_001_0	4	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5832	001	0	1	01	01	H5832_001_0	4	3	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	135.00												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												
H5832	001	0	1	01	01	H5832_001_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.99	50	50	50					33.86	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5832	001	0	1	01	01	H5832_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.60	18.00	36.00	54.00					.46	14.00	28.00	42.00												.60	18.00	36.00	54.00				.46	14.00	28.00	42.00					18.00			.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5852	001	0	1	01	01	H5852_001_0	6	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	6	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												
H5852	001	0	1	01	01	H5852_001_0	6	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												
H5854	007	0	1	01	01	H5854_007_0	13	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.70	21.00	42.00	63.00					.53	16.00	32.00	48.00					.53	16.00	32.00	32.00																		21.00				.61	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	13	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	13	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	13	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	13	5	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, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	13	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		2.00				.05	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	9	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.33	10.00	20.00	30.00					.33	10.00	20.00	30.00					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	9	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.16	5.00	10.00	15.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	9	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.03	31.00	62.00	93.00					1.03	31.00	62.00	93.00					1.03	31.00	93.00	93.00																		31.00				.91	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	9	6	Select Care Drugs	1	3	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												
H5854	008	0	1	01	01	H5854_008_0	9	5	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, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	9	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									3.16	95.00	190.00	285.00					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	13	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	13	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.86	26.00	52.00	78.00					.70	21.00	42.00	63.00					.70	21.00	42.00	42.00																		26.00				.76	26.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	13	5	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, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	13	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	13	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	13	6	Select Care Drugs	1	3	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												
H5883	002	1	1	02	01	H5883_002_1	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		30.00					.29	10.00		25.00					.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	12	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		9.00					.09	3.00		7.50					.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	12	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.18	40.00		120.00					1.18	40.00		100.00					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	12	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.35	80.00		240.00					2.35	80.00		200.00					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	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													198.00	33							198.00	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	12	1	Preferred Generic	3	4	001000	1	1		110	01	110		1				34		90	1	34		90				34		34													5.50	45		45					5.50	45		40					45		40																	45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	002	2	1	02	01	H5883_002_2	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		9.00					.09	3.00		7.50					.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	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		30.00					.29	10.00		25.00					.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	11	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.18	40.00		120.00					1.18	40.00		100.00					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	11	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.35	80.00		240.00					2.35	80.00		200.00					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	2	1	02	01	H5883_002_2	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													198.00	33							198.00	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	11	1	Preferred Generic	3	4	001000	1	1		110	01	110		1				34		90	1	34		90				34		34													5.50	45		45					5.50	45		40					45		40																	45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	002	3	1	02	01	H5883_002_3	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		30.00					.29	10.00		25.00					.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	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		9.00					.09	3.00		7.50					.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	11	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.18	40.00		120.00					1.18	40.00		100.00					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	11	1	Preferred Generic	3	4	001000	1	1		110	01	110		1				34		90	1	34		90				34		34													5.50	45		45					5.50	45		40					45		40																	45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	002	3	1	02	01	H5883_002_3	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													198.00	33							198.00	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	11	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.35	80.00		240.00					2.35	80.00		200.00					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	4	1	02	01	H5883_002_4	12	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		9.00					.09	3.00		7.50					.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	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		30.00					.29	10.00		25.00					.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	12	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.18	40.00		120.00					1.18	40.00		100.00					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	12	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.35	80.00		240.00					2.35	80.00		200.00					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	4	1	02	01	H5883_002_4	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													198.00	33							198.00	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	12	1	Preferred Generic	3	4	001000	1	1		110	01	110		1				34		90	1	34		90				34		34													5.50	45		45					5.50	45		40					45		40																	45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	002	7	1	02	01	H5883_002_7	12	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		9.00					.09	3.00		7.50					.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	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		30.00					.29	10.00		25.00					.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	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													198.00	33							198.00	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	12	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.35	80.00		240.00					2.35	80.00		200.00					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	12	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.18	40.00		120.00					1.18	40.00		100.00					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	12	1	Preferred Generic	3	4	001000	1	1		110	01	110		1				34		90	1	34		90				34		34													5.50	45		45					5.50	45		40					45		40																	45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	003	1	1	02	01	H5883_003_1	12	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		9.00					.09	3.00		7.50					.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	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													198.00	33							198.00	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	12	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.15	5.00		15.00					.15	5.00		12.50					.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	12	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.21	75.00		225.00					2.21	75.00		187.50					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	1	1	02	01	H5883_003_1	12	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.03	35.00		105.00					1.03	35.00		87.50					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	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		30.00					.29	10.00		25.00					.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	11	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.21	75.00		225.00					2.21	75.00		187.50					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	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													198.00	33							198.00	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	11	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.03	35.00		105.00					1.03	35.00		87.50					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	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		30.00					.29	10.00		25.00					.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	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		9.00					.09	3.00		7.50					.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	11	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.15	5.00		15.00					.15	5.00		12.50					.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	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		30.00					.29	10.00		25.00					.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	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		9.00					.09	3.00		7.50					.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	11	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.03	35.00		105.00					1.03	35.00		87.50					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	11	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.15	5.00		15.00					.15	5.00		12.50					.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	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													198.00	33							198.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	11	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.21	75.00		225.00					2.21	75.00		187.50					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	12	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		9.00					.09	3.00		7.50					.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	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		30.00					.29	10.00		25.00					.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	12	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.03	35.00		105.00					1.03	35.00		87.50					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	12	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.21	75.00		225.00					2.21	75.00		187.50					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	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													198.00	33							198.00	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	12	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.15	5.00		15.00					.15	5.00		12.50					.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	12	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		9.00					.09	3.00		7.50					.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	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		30.00					.29	10.00		25.00					.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	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													198.00	33							198.00	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	12	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.21	75.00		225.00					2.21	75.00		187.50					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	12	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.03	35.00		105.00					1.03	35.00		87.50					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	12	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.15	5.00		15.00					.15	5.00		12.50					.15	5.00		12.50																		5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	006	0	1	01	01	H5883_006_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.15	5.00		15.00					.15	5.00		12.50					.15	5.00		12.50																		5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	006	0	1	01	01	H5883_006_0	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.44	15.00		45.00					.44	15.00		37.50					.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	12	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.21	7.00		21.00					.21	7.00		17.50					.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	12	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.79	95.00		285.00					2.79	95.00		237.50					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	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													198.00	33							198.00	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	12	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.32	45.00		135.00					1.32	45.00		112.50					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	007	0	1	01	01	H5883_007_0	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													198.00	33							198.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.15	5.00		15.00					.15	5.00		12.50					.15	5.00		12.50																		5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.44	15.00		45.00					.44	15.00		37.50					.44	15.00		37.50																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	12	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.32	45.00		135.00					1.32	45.00		112.50					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	007	0	1	01	01	H5883_007_0	12	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.79	95.00		285.00					2.79	95.00		237.50					2.79	95.00		237.50																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	001	0	1	01	01	H5887_001_0	13	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	001	0	1	01	01	H5887_001_0	13	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	001	0	1	01	01	H5887_001_0	13	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	001	0	1	01	01	H5887_001_0	13	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	001	0	1	01	01	H5887_001_0	13	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												
H5887	001	0	1	01	01	H5887_001_0	13	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	001	0	1	01	01	H5887_001_0	13	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	11	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												
H5887	007	0	1	01	01	H5887_007_0	11	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.47	14.00		42.00																								28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	007	0	1	01	01	H5887_007_0	11	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	007	0	1	01	01	H5887_007_0	11	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	007	0	1	01	01	H5887_007_0	11	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												
H5887	007	0	1	01	01	H5887_007_0	11	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	007	0	1	01	01	H5887_007_0	11	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.47	14.00		42.00																								28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5887	010	0	1	01	01	H5887_010_0	12	2	Non-Preferred Generic	1	2	000100	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	010	0	1	01	01	H5887_010_0	12	1	Preferred Generic	1	2	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	010	0	1	01	01	H5887_010_0	12	3	Preferred Brand	1	2	000001	1	1	110		01	100		1	30		90				2			90				30		31					48.18	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	010	0	1	01	01	H5887_010_0	12	5	Specialty Tier	1	2	010010	1	1	110		01	100		1	30		90				2			90				30		31						25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	010	0	1	01	01	H5887_010_0	12	4	Non-Preferred Brand	1	2	100000	1	1	110		01	100		1	30		90				2			90				30		31					68.72	25		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	11	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												
H5887	012	0	1	01	01	H5887_012_0	11	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	012	0	1	01	01	H5887_012_0	11	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, Non-Preferred Brand, Specialty Tier												
H5887	012	0	1	01	01	H5887_012_0	11	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.50	75.00		225.00																								150.00																		75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	012	0	1	01	01	H5887_012_0	11	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												
H5887	012	0	1	01	01	H5887_012_0	11	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	012	0	1	01	01	H5887_012_0	11	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	11	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												
H5887	013	0	1	01	01	H5887_013_0	11	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	11	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, Non-Preferred Brand, Specialty Tier												
H5887	013	0	1	01	01	H5887_013_0	11	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.50	75.00		225.00																								150.00																		75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	013	0	1	01	01	H5887_013_0	11	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	11	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												
H5887	013	0	1	01	01	H5887_013_0	11	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		
H5926	001	0	1	01	01	H5926_001_0	7	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	7	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	7	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	7	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	9	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	001	0	1	01	01	H5928_001_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					453.09	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	9	4	Non-Preferred Brand	1	4	100100	1	1	110		01	100		1	30		90				2			90				30		31					58.58	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	9	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31					52.05	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	9	2	Non-Preferred Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31					5.29	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	9	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	10	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	10	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					777.74	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	10	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	10	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	10	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	10	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	10	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	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	005	0	1	01	01	H5928_005_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					453.09	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	7	4	Non-Preferred Brand	1	4	100100	1	1	110		01	100		1	30		90				2			90				30		31					58.58	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	7	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31					52.05	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	7	2	Non-Preferred Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31					5.29	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	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	010	0	1	01	01	H5928_010_0	9	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	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					777.74	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	9	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	2.67	80.00		160.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	9	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	9	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	9	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	010	0	1	01	01	H5928_010_0	9	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	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	012	0	1	01	01	H5928_012_0	8	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	012	0	1	01	01	H5928_012_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	012	0	1	01	01	H5928_012_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					777.74	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	012	0	1	01	01	H5928_012_0	8	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	2.67	80.00		160.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	012	0	1	01	01	H5928_012_0	8	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	012	0	1	01	01	H5928_012_0	8	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	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	016	0	1	01	01	H5928_016_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	016	0	1	01	01	H5928_016_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	016	0	1	01	01	H5928_016_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	016	0	1	01	01	H5928_016_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					777.74	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_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	016	0	1	01	01	H5928_016_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	020	0	1	01	01	H5928_020_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	020	0	1	01	01	H5928_020_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	020	0	1	01	01	H5928_020_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	020	0	1	01	01	H5928_020_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	020	0	1	01	01	H5928_020_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	020	0	1	01	01	H5928_020_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	020	0	1	01	01	H5928_020_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					777.74	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	022	0	1	01	01	H5928_022_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	022	0	1	01	01	H5928_022_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					777.74	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	022	0	1	01	01	H5928_022_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	2.67	80.00		160.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	022	0	1	01	01	H5928_022_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	022	0	1	01	01	H5928_022_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	022	0	1	01	01	H5928_022_0	7	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	022	0	1	01	01	H5928_022_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	024	0	1	01	01	H5928_024_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					777.74	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	024	0	1	01	01	H5928_024_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	024	0	1	01	01	H5928_024_0	6	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	024	0	1	01	01	H5928_024_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	024	0	1	01	01	H5928_024_0	6	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	6	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	024	0	1	01	01	H5928_024_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	2.67	80.00		160.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	025	0	1	01	01	H5928_025_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	025	0	1	01	01	H5928_025_0	6	2	Non-Preferred Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31					5.29	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	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	025	0	1	01	01	H5928_025_0	6	4	Non-Preferred Brand	1	4	100100	1	1	110		01	100		1	30		90				2			90				30		31					58.58	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	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					453.09	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	6	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31					52.05	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	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	037	0	1	01	01	H5928_037_0	8	2	Non-Preferred Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31					5.29	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	8	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31					52.05	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	8	4	Non-Preferred Brand	1	4	100100	1	1	110		01	100		1	30		90				2			90				30		31					58.58	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	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					453.09	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	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	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					777.74	33		33																							33																	33				33	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	0.13	4.00		8.00																								8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	0.13	4.00		8.00																								8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	042	0	1	01	01	H5928_042_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	042	0	1	01	01	H5928_042_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					777.74	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	042	0	1	01	01	H5928_042_0	8	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	2.67	80.00		160.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	042	0	1	01	01	H5928_042_0	8	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	042	0	1	01	01	H5928_042_0	8	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	042	0	1	01	01	H5928_042_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	042	0	1	01	01	H5928_042_0	8	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	044	0	1	01	01	H5928_044_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	044	0	1	01	01	H5928_044_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	044	0	1	01	01	H5928_044_0	7	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	2.67	80.00		160.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					777.74	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_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	044	0	1	01	01	H5928_044_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	046	0	1	01	01	H5928_046_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	046	0	1	01	01	H5928_046_0	6	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	046	0	1	01	01	H5928_046_0	6	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	046	0	1	01	01	H5928_046_0	6	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	046	0	1	01	01	H5928_046_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					777.74	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	046	0	1	01	01	H5928_046_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	046	0	1	01	01	H5928_046_0	6	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	6	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, Select Care Drugs												
H5932	007	0	1	01	01	H5932_007_0	6	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	6	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	6	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	6	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	6	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	6	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, Select Care Drugs												
H5932	008	0	1	01	01	H5932_008_0	6	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	6	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	6	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	6	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	6	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	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												
H5938	001	0	1	01	01	H5938_001_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	001	0	1	01	01	H5938_001_0	9	4	Non-Preferred Brand	1	4	110000	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	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	001	0	1	01	01	H5938_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	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	001	0	1	01	01	H5938_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	.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	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	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	7	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	7	4	Non-Preferred Brand	1	4	110000	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	237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_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	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_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	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	7	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	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	7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5943	001	0	1	02	01	H5943_001_0	9	3	Preferred Brand	1	4	000001	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31					93.44	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	9	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, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	9	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31					143.02	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					514.37	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	9	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	30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_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	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	001	0	1	01	01	H5945_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	.33	10.00	20.00	30.00																					.33	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	001	0	1	01	01	H5945_001_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	8.00	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	001	0	1	01	01	H5945_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	2.66	80.00	160.00	240.00																					2.60	80.00	160.00	160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	001	0	1	01	01	H5945_001_0	9	2	Non-Preferred Generic	3	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	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5945	001	0	1	01	01	H5945_001_0	9	1	Preferred Generic	3	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	8.00	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5945	001	0	1	01	01	H5945_001_0	9	5	Specialty Tier	1	4	000010	1	1	010		10	010		1	30							30							10	31					600.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	002	0	1	01	01	H5945_002_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	8.00	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	002	0	1	01	01	H5945_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	.33	10.00	20.00	30.00																					.33	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	002	0	1	01	01	H5945_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	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	002	0	1	01	01	H5945_002_0	8	1	Preferred Generic	3	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	8.00	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5945	002	0	1	01	01	H5945_002_0	8	5	Specialty Tier	1	4	000010	1	1	010		10	010		1	30							30							10	31					600.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	002	0	1	01	01	H5945_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	2.66	80.00	160.00	240.00																					2.60	80.00	160.00	160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	002	0	1	01	01	H5945_002_0	8	2	Non-Preferred Generic	3	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	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5970	001	0	1	04	01	H5970_001_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		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												
H5970	001	0	1	04	01	H5970_001_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	3	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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	3	5	Specialty Tier	1	3	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												
H5970	001	0	1	04	01	H5970_001_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		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												
H5970	002	0	1	04	01	H5970_002_0	3	5	Specialty Tier	1	4	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												
H5970	002	0	1	04	01	H5970_002_0	3	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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	002	0	1	04	01	H5970_002_0	3	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		60.00				0.66	20.00		0.00				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	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		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										2	3	
H5970	002	0	1	04	01	H5970_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		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												
H5970	002	0	1	04	01	H5970_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		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												
H5970	002	0	1	04	01	H5970_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		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										2	3	
H5970	002	0	1	04	01	H5970_002_0	3	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		30.00				0.33	10.00		0.00				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	3	5	Specialty Tier	3	4	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										2	3	
H5970	002	0	1	04	01	H5970_002_0	3	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		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	004	0	1	04	01	H5970_004_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5970	004	0	1	04	01	H5970_004_0	3	5	Specialty Tier	3	4	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										2	3	
H5970	004	0	1	04	01	H5970_004_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		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										2	3	
H5970	004	0	1	04	01	H5970_004_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		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										2	3	
H5970	004	0	1	04	01	H5970_004_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	004	0	1	04	01	H5970_004_0	3	5	Specialty Tier	1	4	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												
H5970	004	0	1	04	01	H5970_004_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		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												
H5970	004	0	1	04	01	H5970_004_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		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												
H5970	004	0	1	04	01	H5970_004_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	004	0	1	04	01	H5970_004_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		18.00				0.20	6.00		0.00				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	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	008	0	1	04	01	H5970_008_0	3	5	Specialty Tier	3	4	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										2	3	
H5970	008	0	1	04	01	H5970_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		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										2	3	
H5970	008	0	1	04	01	H5970_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		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										2	3	
H5970	008	0	1	04	01	H5970_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5970	008	0	1	04	01	H5970_008_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	008	0	1	04	01	H5970_008_0	3	5	Specialty Tier	1	4	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												
H5970	008	0	1	04	01	H5970_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		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												
H5970	008	0	1	04	01	H5970_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		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												
H5970	008	0	1	04	01	H5970_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	010	0	1	04	01	H5970_010_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		18.00				0.20	6.00		0.00				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	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		45.00				0.50	15.00		0.00				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	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		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												
H5970	010	0	1	04	01	H5970_010_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		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												
H5970	010	0	1	04	01	H5970_010_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		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										2	3	
H5970	010	0	1	04	01	H5970_010_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		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										2	3	
H5970	010	0	1	04	01	H5970_010_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	010	0	1	04	01	H5970_010_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		45.00				0.50	15.00		0.00				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	3	5	Specialty Tier	3	4	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										2	3	
H5970	010	0	1	04	01	H5970_010_0	3	5	Specialty Tier	1	4	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												
H5985	001	0	1	01	01	H5985_001_0	5	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	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	5	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	25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.83	25.00	50.00	75.00																					.83	25.00	50.00	62.50																		25.00				.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.50	75.00	150.00	225.00																					2.50	75.00	150.00	187.50																		75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	5	5	Specialty Tier	1	4	100101	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_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				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5985	005	0	1	01	01	H5985_005_0	5	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	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	5	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	25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_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				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5985	005	0	1	01	01	H5985_005_0	5	5	Specialty Tier	1	4	100101	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.50	75.00	150.00	225.00																					2.50	75.00	150.00	187.50																		75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.83	25.00	50.00	75.00																					.83	25.00	50.00	62.50																		25.00				.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-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	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	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	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	11	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	112.50																								112.50																		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	11	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.43	13.00	26.00	32.50																								32.50																		13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	11	1	Preferred Generic	1	2	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												
H5991	001	0	1	01	01	H5991_001_0	11	4	Non-Preferred Brand	1	2	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	11	5	Specialty Tier	1	2	010010	1	1	010		01			1	30													30		31					840.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	11	1	Preferred Generic	1	2	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												
H5991	002	0	1	01	01	H5991_002_0	11	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.43	13.00	26.00	32.50																								32.50																		13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	11	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	112.50																								112.50																		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	11	4	Non-Preferred Brand	1	2	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	11	5	Specialty Tier	1	2	010010	1	1	010		01			1	30													30		31					840.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_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	112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.33	10.00	20.00	25.00																								25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_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												
H5991	003	0	1	01	01	H5991_003_0	8	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	95.00	190.00	237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	8	1	Preferred Generic	3	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										1		
H5991	003	0	1	01	01	H5991_003_0	8	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1108.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_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												
H5991	004	0	1	01	01	H5991_004_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.26	8.00	16.00	20.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.40	42.00	84.00	105.50																								105.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	8	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.17	95.00	190.00	237.50																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	8	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1108.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	8	1	Preferred Generic	3	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										1		
H5991	005	0	1	01	01	H5991_005_0	10	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												
H5991	005	0	1	01	01	H5991_005_0	10	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.23	7.00	14.00	17.50																								17.50																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	005	0	1	01	01	H5991_005_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.33	40.00	80.00	100.00																								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	005	0	1	01	01	H5991_005_0	10	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1108.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	005	0	1	01	01	H5991_005_0	10	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.00	90.00	180.00	225.00																								225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	005	0	1	01	01	H5991_005_0	10	1	Preferred Generic	3	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										1		
H6080	001	0	1	48	05	H6080_001_0	3	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	3	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	0.00	6.60	0.00	6.60			0.00	6.60			
H6080	001	0	1	48	05	H6080_001_0	3	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	0.00	2.65	0.00	2.65			0.00	2.65			
H6181	007	0	1	01	01	H6181_007_0	8	5	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, Specialty Tier, Select Care Drugs												
H6181	007	0	1	01	01	H6181_007_0	8	6	Select Care Drugs	1	3	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												
H6181	007	0	1	01	01	H6181_007_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.13	94.00	188.00	282.00					2.96	89.00	178.00	267.00					2.96	89.00	267.00	267.00																		94.00				2.76	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6181	007	0	1	01	01	H6181_007_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.93	28.00	56.00	84.00					.93	28.00	56.00	84.00					.93	28.00	84.00	84.00																		28.00				.82	28.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6181	007	0	1	01	01	H6181_007_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.16	5.00	10.00	15.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6181	007	0	1	01	01	H6181_007_0	8	2	Non-Preferred Generic	1	3	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	60.00					.66	20.00	40.00	40.00																		20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6181	009	0	1	01	01	H6181_009_0	10	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6181	009	0	1	01	01	H6181_009_0	10	5	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, Specialty Tier, Select Care Drugs												
H6181	009	0	1	01	01	H6181_009_0	10	6	Select Care Drugs	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												
H6181	009	0	1	01	01	H6181_009_0	10	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					.50	15.00	30.00	45.00					.50	15.00	30.00	30.00																		20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6181	009	0	1	01	01	H6181_009_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6181	009	0	1	01	01	H6181_009_0	10	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6229	005	0	1	48	05	H6229_005_0	8	1	Generic Drugs	1	4	010010			111		10	111		1	31	62	93				1	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	6.60			0.00	6.60	0.00	6.60			
H6229	005	0	1	48	05	H6229_005_0	8	4	Non-Medicare OTC Drugs	1	4	010010			010		10			1	31														10	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			
H6229	005	0	1	48	05	H6229_005_0	8	3	Non-Medicare Rx Drugs	1	4	010010			010		10			1	31														10	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			
H6229	005	0	1	48	05	H6229_005_0	8	2	Brand Drugs	1	4	010010			111		10	111		1	31	62	93				1	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	6.60			0.00	6.60	0.00	6.60			
H6229	006	0	1	48	05	H6229_006_0	8	1	Generic Drugs	1	4	010010			111		10	111		1	31	62	93				1	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	6.60			0.00	6.60	0.00	6.60			
H6229	006	0	1	48	05	H6229_006_0	8	4	Non-Medicare OTC Drugs	1	4	010010			010		10			1	31														10	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			
H6229	006	0	1	48	05	H6229_006_0	8	3	Non-Medicare Rx Drugs	1	4	010010			010		10			1	31														10	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			
H6229	006	0	1	48	05	H6229_006_0	8	2	Brand Drugs	1	4	010010			111		10	111		1	31	62	93				1	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	6.60			0.00	6.60	0.00	6.60			
H6229	007	0	1	48	05	H6229_007_0	8	4	Non-Medicare OTC Drugs	1	4	010010			010		10			1	31														10	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			
H6229	007	0	1	48	05	H6229_007_0	8	3	Non-Medicare Rx Drugs	1	4	010010			010		10			1	31														10	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			
H6229	007	0	1	48	05	H6229_007_0	8	1	Generic Drugs	1	4	010010			111		10	111		1	31	62	93				1	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	6.60			0.00	6.60	0.00	6.60			
H6229	007	0	1	48	05	H6229_007_0	8	2	Brand Drugs	1	4	010010			111		10	111		1	31	62	93				1	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	6.60			0.00	6.60	0.00	6.60			
H6237	003	1	1	01	01	H6237_003_1	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		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												
H6237	003	1	1	01	01	H6237_003_1	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.40	12.00		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6237	003	1	1	01	01	H6237_003_1	9	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												
H6237	003	1	1	01	01	H6237_003_1	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6237	003	1	1	01	01	H6237_003_1	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6237	003	2	1	01	01	H6237_003_2	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6237	003	2	1	01	01	H6237_003_2	9	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												
H6237	003	2	1	01	01	H6237_003_2	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.40	12.00		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6237	003	2	1	01	01	H6237_003_2	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		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												
H6237	003	2	1	01	01	H6237_003_2	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6263	001	0	1	48	05	H6263_001_0	5	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 Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6263	001	0	1	48	05	H6263_001_0	5	3	Non-Medicare Rx Drugs	1	4	010010			111		01	111		1	30	60	90				2	30	60	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			
H6263	001	0	1	48	05	H6263_001_0	5	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 Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6263	001	0	1	48	05	H6263_001_0	5	4	Non-Medicare OTC Drugs	1	4	010010			111		01	111		1	30	60	90				2	30	60	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			
H6298	001	0	1	01	01	H6298_001_0	7	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, Vaccines												
H6298	001	0	1	01	01	H6298_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.46	14.00		42.00																					.46	14.00		28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	001	0	1	01	01	H6298_001_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												
H6298	001	0	1	01	01	H6298_001_0	7	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				1	30		90				30		31					1210.23	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	001	0	1	01	01	H6298_001_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																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	001	0	1	01	01	H6298_001_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																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	002	0	1	01	01	H6298_002_0	10	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				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	002	0	1	01	01	H6298_002_0	10	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				1	30		90				30		31					1210.23	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	002	0	1	01	01	H6298_002_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		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												
H6298	002	0	1	01	01	H6298_002_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		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												
H6298	002	0	1	01	01	H6298_002_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.45	14.00		42.00																					.45	14.00		28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	002	0	1	01	01	H6298_002_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												
H6298	003	0	1	01	01	H6298_003_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		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												
H6298	003	0	1	01	01	H6298_003_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.45	14.00		42.00																					.45	14.00		28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	003	0	1	01	01	H6298_003_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.12	4.00		12.00																					.12	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	003	0	1	01	01	H6298_003_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		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												
H6298	003	0	1	01	01	H6298_003_0	8	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				1	30		90				30		31					1184.04	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	003	0	1	01	01	H6298_003_0	8	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												
H6298	004	0	1	01	01	H6298_004_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		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												
H6298	004	0	1	01	01	H6298_004_0	12	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				1	30		90				30		31					1210.23	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	004	0	1	01	01	H6298_004_0	12	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												
H6298	004	0	1	01	01	H6298_004_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																					.13	4.00		8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	004	0	1	01	01	H6298_004_0	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.45	14.00		42.00																					.45	14.00		28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	004	0	1	01	01	H6298_004_0	12	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	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, Vaccines												
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	0.10	3.00	6.00	9.00																					0.10	3.00	0.00	0.00																		3.00				.10	3.00		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												
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	0.10	3.00	6.00	9.00																					.10	3.00	0.00	0.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6308	001	0	1	48	05	H6308_001_0	7	2	Brand Drugs	1	4	000010			111		01	100		1	30	60	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			
H6308	001	0	1	48	05	H6308_001_0	7	3	Non-Medicare Rx/OTC Drugs	1	4	010010			111		01	100		1	30	60	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			
H6308	001	0	1	48	05	H6308_001_0	7	1	Generic Drugs	1	4	010000			111		01	100		1	30	60	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			
H6328	001	0	1	04	01	H6328_001_0	10	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	10	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	10	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	10	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	10	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	001	0	1	04	01	H6328_001_0	10	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	002	0	1	04	01	H6328_002_0	9	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	9	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	9	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	002	0	1	04	01	H6328_002_0	9	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	9	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	9	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	003	0	1	04	01	H6328_003_0	9	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	9	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	9	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	9	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	9	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												
H6328	003	0	1	04	01	H6328_003_0	9	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												
H6360	001	0	1	18	06	H6360_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		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	001	0	1	18	06	H6360_001_0	6	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, Vaccines												
H6360	001	0	1	18	06	H6360_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												
H6360	001	0	1	18	06	H6360_001_0	6	1	Preferred Generic	3	4	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, Vaccines										1		
H6360	001	0	1	18	06	H6360_001_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.45	14.00		28.00																					.45	14.00		28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	001	0	1	18	06	H6360_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		
H6360	001	0	1	18	06	H6360_001_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				1	30		90				30		31					1205.22	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	001	0	1	18	06	H6360_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.46	14.00		42.00																					.45	14.00		28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	001	0	1	18	06	H6360_001_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		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	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																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				1	30		90				30		31					1205.22	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_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												
H6360	002	0	1	18	06	H6360_002_0	5	1	Preferred Generic	3	4	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, Vaccines										1		
H6360	002	0	1	18	06	H6360_002_0	5	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, Vaccines												
H6360	002	0	1	18	06	H6360_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		
H6360	002	0	1	18	06	H6360_002_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																		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	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.46	14.00		42.00																					.46	14.00		28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.45	14.00		28.00																					.45	14.00		28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	006	0	1	18	06	H6360_006_0	5	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																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	006	0	1	18	06	H6360_006_0	5	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	30		90				1	30		90				30		31					1311.30	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	006	0	1	18	06	H6360_006_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												
H6360	006	0	1	18	06	H6360_006_0	5	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.17	5.00		15.00																					.17	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	006	0	1	18	06	H6360_006_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.67	20.00		60.00																					.67	20.00		40.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	006	0	1	18	06	H6360_006_0	5	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																		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	4	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				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.46	14.00		42.00																					.46	14.00		28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	009	0	2	18	06	H6360_009_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.45	14.00		28.00																					.45	14.00		28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	009	0	2	18	06	H6360_009_0	4	1	Preferred Generic	3	4	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, Vaccines										1		
H6360	009	0	2	18	06	H6360_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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_0	4	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				1	30		90				30		31					1245.87	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_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		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	4	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																		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	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, Vaccines												
H6360	010	0	1	18	06	H6360_010_0	5	2	Non-Preferred Generic	1	3	000100	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				.97	30.00		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	30		90				1	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												
H6360	010	0	1	18	06	H6360_010_0	5	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	30		90				1	30		90				30		31					1112.08	33		33																					33		33																	33				33	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	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		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			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												
H6435	001	0	1	48	05	H6435_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	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6435	001	0	1	48	05	H6435_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			
H6435	001	0	1	48	05	H6435_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	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6528	006	0	1	04	01	H6528_006_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					752.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															9.00							6.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.40	12.00		36.00																															36.00							24.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	006	0	1	04	01	H6528_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																															135.00							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_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							275.00				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	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.43	13.00		39.00																															39.00							26.00				13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	016	0	1	04	01	H6528_016_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					673.00	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	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							275.00				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	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							125.00				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	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															9.00							6.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	029	0	1	04	01	H6528_029_0	4	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							18.00				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	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															9.00							6.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	029	0	1	04	01	H6528_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																															285.00							275.00				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	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							125.00				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	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					686.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	030	0	1	04	01	H6528_030_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					789.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	030	0	1	04	01	H6528_030_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							275.00				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	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							125.00				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	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							22.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	030	0	1	04	01	H6528_030_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																															12.00							8.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	001	0	1	01	01	H6560_001_0	3	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	10.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6560	001	0	1	01	01	H6560_001_0	3	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	10.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	001	0	1	01	01	H6560_001_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	17.50					0.10	3.00	6.00	7.50												0.23	7.00	14.00	17.50				0.10	3.00	6.00	7.50					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	001	0	1	01	01	H6560_001_0	3	3	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	112.50					1.50	45.00	90.00	112.50												1.50	45.00	90.00	112.50				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												
H6560	001	0	1	01	01	H6560_001_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													38.85	50	50	50					36.32	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	001	0	1	01	01	H6560_001_0	3	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	002	0	1	01	01	H6560_002_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.78	50	50	50					35.13	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	002	0	1	01	01	H6560_002_0	3	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	002	0	1	01	01	H6560_002_0	3	3	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	135.00												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												
H6560	002	0	1	01	01	H6560_002_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.56	17.00	34.00	51.00					0.36	11.00	22.00	33.00												0.56	17.00	34.00	51.00				0.36	11.00	22.00	33.00					17.00			0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	002	0	1	01	01	H6560_002_0	3	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00	20.00	30.00				0.13	4.00	8.00	12.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	003	0	1	01	01	H6560_003_0	3	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	003	0	1	01	01	H6560_003_0	3	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00	20.00	30.00				0.13	4.00	8.00	12.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	003	0	1	01	01	H6560_003_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.56	17.00	34.00	51.00					0.36	11.00	22.00	33.00												0.56	17.00	34.00	51.00				0.36	11.00	22.00	33.00					17.00			0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	003	0	1	01	01	H6560_003_0	3	3	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	135.00												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												
H6560	003	0	1	01	01	H6560_003_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.78	50	50	50					35.13	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	004	0	1	01	01	H6560_004_0	4	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	004	0	1	01	01	H6560_004_0	4	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00	20.00	30.00				0.13	4.00	8.00	12.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	004	0	1	01	01	H6560_004_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.56	17.00	34.00	51.00					0.36	11.00	22.00	33.00												0.56	17.00	34.00	51.00				0.36	11.00	22.00	33.00					17.00			0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6560	004	0	1	01	01	H6560_004_0	4	3	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	135.00												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												
H6560	004	0	1	01	01	H6560_004_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													38.01	50	50	50					35.34	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	4	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_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		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												
H6609	001	0	1	04	01	H6609_001_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		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												
H6609	001	0	1	04	01	H6609_001_0	4	5	Specialty Tier	1	3	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												
H6609	003	0	1	04	01	H6609_003_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		15.00				0.16	5.00		0.00				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	3	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		33.00				0.36	11.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	003	0	1	04	01	H6609_003_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		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												
H6609	003	0	1	04	01	H6609_003_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		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												
H6609	003	0	1	04	01	H6609_003_0	3	5	Specialty Tier	1	3	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												
H6609	005	0	1	04	01	H6609_005_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		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	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		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												
H6609	005	0	1	04	01	H6609_005_0	5	5	Specialty Tier	1	3	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												
H6609	005	0	1	04	01	H6609_005_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		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												
H6609	009	0	1	04	01	H6609_009_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		12.00				0.13	4.00		0.00				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	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		21.00				0.23	7.00		0.00				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	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		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												
H6609	009	0	1	04	01	H6609_009_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		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												
H6609	009	0	1	04	01	H6609_009_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	009	0	1	04	01	H6609_009_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	009	0	1	04	01	H6609_009_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		21.00				0.23	7.00		0.00				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	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		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										2	3	
H6609	009	0	1	04	01	H6609_009_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		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										2	3	
H6609	009	0	1	04	01	H6609_009_0	3	5	Specialty Tier	1	4	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												
H6609	013	0	1	04	01	H6609_013_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		12.00				0.13	4.00		0.00				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	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	013	0	1	04	01	H6609_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		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												
H6609	013	0	1	04	01	H6609_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		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												
H6609	013	0	1	04	01	H6609_013_0	3	5	Specialty Tier	1	4	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												
H6609	013	0	1	04	01	H6609_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		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										2	3	
H6609	013	0	1	04	01	H6609_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		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										2	3	
H6609	013	0	1	04	01	H6609_013_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	013	0	1	04	01	H6609_013_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	013	0	1	04	01	H6609_013_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	017	0	1	04	01	H6609_017_0	3	5	Specialty Tier	1	3	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												
H6609	017	0	1	04	01	H6609_017_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		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												
H6609	017	0	1	04	01	H6609_017_0	3	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	3	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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_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		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												
H6609	019	0	1	04	01	H6609_019_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		270.00				3.00	90.00		260.00				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	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		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										2	3	
H6609	019	0	1	04	01	H6609_019_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		45.00				0.50	15.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	019	0	1	04	01	H6609_019_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	019	0	1	04	01	H6609_019_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		270.00				3.00	90.00		260.00				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	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		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												
H6609	019	0	1	04	01	H6609_019_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		45.00				0.50	15.00		0.00				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	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		15.00				0.16	5.00		0.00				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	3	5	Specialty Tier	1	4	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												
H6609	029	0	1	04	01	H6609_029_0	3	5	Specialty Tier	1	4	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												
H6609	029	0	1	04	01	H6609_029_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	029	0	1	04	01	H6609_029_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	029	0	1	04	01	H6609_029_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		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										2	3	
H6609	029	0	1	04	01	H6609_029_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		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												
H6609	029	0	1	04	01	H6609_029_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	029	0	1	04	01	H6609_029_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		15.00				0.16	5.00		0.00				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	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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	029	0	1	04	01	H6609_029_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		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												
H6609	029	0	1	04	01	H6609_029_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		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										2	3	
H6609	074	0	1	04	01	H6609_074_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	074	0	1	04	01	H6609_074_0	3	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		45.00				0.50	15.00		0.00				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	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		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												
H6609	074	0	1	04	01	H6609_074_0	3	5	Specialty Tier	1	3	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												
H6609	074	0	1	04	01	H6609_074_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		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												
H6609	075	0	1	04	01	H6609_075_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		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										2	3	
H6609	075	0	1	04	01	H6609_075_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	075	0	1	04	01	H6609_075_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		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										2	3	
H6609	075	0	1	04	01	H6609_075_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		30.00				0.33	10.00		0.00				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	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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	075	0	1	04	01	H6609_075_0	3	5	Specialty Tier	1	4	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												
H6609	075	0	1	04	01	H6609_075_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		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												
H6609	075	0	1	04	01	H6609_075_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		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												
H6609	075	0	1	04	01	H6609_075_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		30.00				0.33	10.00		0.00				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	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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_0	3	5	Specialty Tier	1	4	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												
H6609	077	0	1	04	01	H6609_077_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		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												
H6609	077	0	1	04	01	H6609_077_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		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												
H6609	077	0	1	04	01	H6609_077_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	077	0	1	04	01	H6609_077_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	077	0	1	04	01	H6609_077_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		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										2	3	
H6609	077	0	1	04	01	H6609_077_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	077	0	1	04	01	H6609_077_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_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		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										2	3	
H6609	078	0	1	04	01	H6609_078_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	078	0	1	04	01	H6609_078_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		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										2	3	
H6609	078	0	1	04	01	H6609_078_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				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	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		54.00				0.60	18.00		0.00				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	3	5	Specialty Tier	1	4	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												
H6609	078	0	1	04	01	H6609_078_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	078	0	1	04	01	H6609_078_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		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										2	3	
H6609	078	0	1	04	01	H6609_078_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		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												
H6609	078	0	1	04	01	H6609_078_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		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												
H6609	080	0	1	04	01	H6609_080_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_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		18.00				0.20	6.00		0.00				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	3	5	Specialty Tier	3	4	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										2	3	
H6609	080	0	1	04	01	H6609_080_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		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										2	3	
H6609	080	0	1	04	01	H6609_080_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		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										2	3	
H6609	080	0	1	04	01	H6609_080_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	080	0	1	04	01	H6609_080_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	080	0	1	04	01	H6609_080_0	3	5	Specialty Tier	1	4	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												
H6609	080	0	1	04	01	H6609_080_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		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												
H6609	080	0	1	04	01	H6609_080_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		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												
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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				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	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		54.00				0.60	18.00		0.00				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	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		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										2	3	
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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		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						25																														25							25					25				25	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	1	4	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												
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		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												
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		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												
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		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										2	3	
H6609	082	0	1	04	01	H6609_082_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		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												
H6609	082	0	1	04	01	H6609_082_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				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	3	5	Specialty Tier	3	4	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										2	3	
H6609	082	0	1	04	01	H6609_082_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		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										2	3	
H6609	082	0	1	04	01	H6609_082_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		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										2	3	
H6609	082	0	1	04	01	H6609_082_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	082	0	1	04	01	H6609_082_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		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												
H6609	082	0	1	04	01	H6609_082_0	3	5	Specialty Tier	1	4	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												
H6609	083	0	1	04	01	H6609_083_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	083	0	1	04	01	H6609_083_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		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												
H6609	083	0	1	04	01	H6609_083_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		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												
H6609	083	0	1	04	01	H6609_083_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	083	0	1	04	01	H6609_083_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		54.00				0.60	18.00		0.00				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	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		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										2	3	
H6609	083	0	1	04	01	H6609_083_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		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										2	3	
H6609	083	0	1	04	01	H6609_083_0	3	5	Specialty Tier	1	4	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												
H6609	084	0	1	04	01	H6609_084_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		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										2	3	
H6609	084	0	1	04	01	H6609_084_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	084	0	1	04	01	H6609_084_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	084	0	1	04	01	H6609_084_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		54.00				0.60	18.00		0.00				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	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		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												
H6609	084	0	1	04	01	H6609_084_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		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												
H6609	084	0	1	04	01	H6609_084_0	3	5	Specialty Tier	1	4	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												
H6609	084	0	1	04	01	H6609_084_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	084	0	1	04	01	H6609_084_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		54.00				0.60	18.00		0.00				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	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		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										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		54.00				0.60	18.00		0.00				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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	085	0	1	04	01	H6609_085_0	4	5	Specialty Tier	1	4	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												
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		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												
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						25																														25							25					25				25	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	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		54.00				0.60	18.00		0.00				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	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		21.00				0.23	7.00		0.00				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	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		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										2	3	
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		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										2	3	
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		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												
H6609	086	0	1	04	01	H6609_086_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	086	0	1	04	01	H6609_086_0	3	5	Specialty Tier	1	4	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												
H6609	086	0	1	04	01	H6609_086_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		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												
H6609	086	0	1	04	01	H6609_086_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		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												
H6609	086	0	1	04	01	H6609_086_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				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	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		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										2	3	
H6609	086	0	1	04	01	H6609_086_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	086	0	1	04	01	H6609_086_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		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										2	3	
H6609	088	0	1	04	01	H6609_088_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	088	0	1	04	01	H6609_088_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	088	0	1	04	01	H6609_088_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	088	0	1	04	01	H6609_088_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		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										2	3	
H6609	088	0	1	04	01	H6609_088_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		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										2	3	
H6609	088	0	1	04	01	H6609_088_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	088	0	1	04	01	H6609_088_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		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												
H6609	088	0	1	04	01	H6609_088_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		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												
H6609	088	0	1	04	01	H6609_088_0	3	5	Specialty Tier	1	4	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												
H6609	088	0	1	04	01	H6609_088_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	089	0	1	04	01	H6609_089_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		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												
H6609	089	0	1	04	01	H6609_089_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		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												
H6609	089	0	1	04	01	H6609_089_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	089	0	1	04	01	H6609_089_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	089	0	1	04	01	H6609_089_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	090	0	1	04	01	H6609_090_0	3	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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	090	0	1	04	01	H6609_090_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		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												
H6609	090	0	1	04	01	H6609_090_0	3	5	Specialty Tier	1	3	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												
H6609	090	0	1	04	01	H6609_090_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		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												
H6609	090	0	1	04	01	H6609_090_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	091	0	1	04	01	H6609_091_0	3	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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	091	0	1	04	01	H6609_091_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		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												
H6609	091	0	1	04	01	H6609_091_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		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												
H6609	091	0	1	04	01	H6609_091_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	091	0	1	04	01	H6609_091_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	092	0	1	04	01	H6609_092_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		270.00				3.00	90.00		260.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	092	0	1	04	01	H6609_092_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		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										2	3	
H6609	092	0	1	04	01	H6609_092_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	092	0	1	04	01	H6609_092_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	092	0	1	04	01	H6609_092_0	3	5	Specialty Tier	1	4	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												
H6609	092	0	1	04	01	H6609_092_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		270.00				3.00	90.00		260.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	092	0	1	04	01	H6609_092_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		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												
H6609	092	0	1	04	01	H6609_092_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	092	0	1	04	01	H6609_092_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	092	0	1	04	01	H6609_092_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	095	0	1	04	01	H6609_095_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	095	0	1	04	01	H6609_095_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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	095	0	1	04	01	H6609_095_0	4	5	Specialty Tier	3	4	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										2	3	
H6609	095	0	1	04	01	H6609_095_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		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										2	3	
H6609	095	0	1	04	01	H6609_095_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		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										2	3	
H6609	095	0	1	04	01	H6609_095_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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	095	0	1	04	01	H6609_095_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	095	0	1	04	01	H6609_095_0	4	5	Specialty Tier	1	4	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												
H6609	095	0	1	04	01	H6609_095_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		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												
H6609	095	0	1	04	01	H6609_095_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		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												
H6609	096	0	1	04	01	H6609_096_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	096	0	1	04	01	H6609_096_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		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										2	3	
H6609	096	0	1	04	01	H6609_096_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		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										2	3	
H6609	096	0	1	04	01	H6609_096_0	5	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	096	0	1	04	01	H6609_096_0	5	5	Specialty Tier	3	4	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										2	3	
H6609	096	0	1	04	01	H6609_096_0	5	5	Specialty Tier	1	4	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												
H6609	096	0	1	04	01	H6609_096_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		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												
H6609	096	0	1	04	01	H6609_096_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		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												
H6609	096	0	1	04	01	H6609_096_0	5	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	096	0	1	04	01	H6609_096_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	097	0	1	04	01	H6609_097_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		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										2	3	
H6609	097	0	1	04	01	H6609_097_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	097	0	1	04	01	H6609_097_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																												0.06	2.00		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												
H6609	097	0	1	04	01	H6609_097_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	097	0	1	04	01	H6609_097_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		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												
H6609	097	0	1	04	01	H6609_097_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		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												
H6609	097	0	1	04	01	H6609_097_0	3	5	Specialty Tier	1	4	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												
H6609	097	0	1	04	01	H6609_097_0	3	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		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										2	3	
H6609	097	0	1	04	01	H6609_097_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	097	0	1	04	01	H6609_097_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		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										2	3	
H6609	098	0	1	04	01	H6609_098_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	098	0	1	04	01	H6609_098_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	098	0	1	04	01	H6609_098_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	098	0	1	04	01	H6609_098_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		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										2	3	
H6609	098	0	1	04	01	H6609_098_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		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										2	3	
H6609	098	0	1	04	01	H6609_098_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	098	0	1	04	01	H6609_098_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		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												
H6609	098	0	1	04	01	H6609_098_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		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												
H6609	098	0	1	04	01	H6609_098_0	3	5	Specialty Tier	1	4	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												
H6609	098	0	1	04	01	H6609_098_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	099	0	1	04	01	H6609_099_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		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												
H6609	099	0	1	04	01	H6609_099_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		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												
H6609	099	0	1	04	01	H6609_099_0	3	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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	099	0	1	04	01	H6609_099_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	099	0	1	04	01	H6609_099_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	100	0	1	04	01	H6609_100_0	3	5	Specialty Tier	1	4	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												
H6609	100	0	1	04	01	H6609_100_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	100	0	1	04	01	H6609_100_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	100	0	1	04	01	H6609_100_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	100	0	1	04	01	H6609_100_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		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												
H6609	100	0	1	04	01	H6609_100_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		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										2	3	
H6609	100	0	1	04	01	H6609_100_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	100	0	1	04	01	H6609_100_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	100	0	1	04	01	H6609_100_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		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												
H6609	100	0	1	04	01	H6609_100_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		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										2	3	
H6609	101	0	1	04	01	H6609_101_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	101	0	1	04	01	H6609_101_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	101	0	1	04	01	H6609_101_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	101	0	1	04	01	H6609_101_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	101	0	1	04	01	H6609_101_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		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										2	3	
H6609	101	0	1	04	01	H6609_101_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		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										2	3	
H6609	101	0	1	04	01	H6609_101_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	101	0	1	04	01	H6609_101_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		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												
H6609	101	0	1	04	01	H6609_101_0	3	5	Specialty Tier	1	4	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												
H6609	101	0	1	04	01	H6609_101_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		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												
H6609	102	0	1	04	01	H6609_102_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		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												
H6609	102	0	1	04	01	H6609_102_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		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												
H6609	102	0	1	04	01	H6609_102_0	3	5	Specialty Tier	1	3	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												
H6609	102	0	1	04	01	H6609_102_0	3	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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	102	0	1	04	01	H6609_102_0	3	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	103	0	1	04	01	H6609_103_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						26																														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	103	0	1	04	01	H6609_103_0	3	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	103	0	1	04	01	H6609_103_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		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												
H6609	103	0	1	04	01	H6609_103_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		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												
H6609	103	0	1	04	01	H6609_103_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	104	0	1	04	01	H6609_104_0	3	5	Specialty Tier	1	3	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												
H6609	104	0	1	04	01	H6609_104_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		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												
H6609	104	0	1	04	01	H6609_104_0	3	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		33.00				0.36	11.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	104	0	1	04	01	H6609_104_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		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												
H6609	104	0	1	04	01	H6609_104_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	105	0	1	04	01	H6609_105_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	105	0	1	04	01	H6609_105_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		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										2	3	
H6609	105	0	1	04	01	H6609_105_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	105	0	1	04	01	H6609_105_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	105	0	1	04	01	H6609_105_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		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												
H6609	105	0	1	04	01	H6609_105_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		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												
H6609	105	0	1	04	01	H6609_105_0	3	5	Specialty Tier	1	4	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												
H6609	105	0	1	04	01	H6609_105_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	105	0	1	04	01	H6609_105_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	105	0	1	04	01	H6609_105_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		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										2	3	
H6609	106	0	1	04	01	H6609_106_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	106	0	1	04	01	H6609_106_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		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										2	3	
H6609	106	0	1	04	01	H6609_106_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	106	0	1	04	01	H6609_106_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	106	0	1	04	01	H6609_106_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	106	0	1	04	01	H6609_106_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		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												
H6609	106	0	1	04	01	H6609_106_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		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												
H6609	106	0	1	04	01	H6609_106_0	4	5	Specialty Tier	3	4	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										2	3	
H6609	106	0	1	04	01	H6609_106_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		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										2	3	
H6609	106	0	1	04	01	H6609_106_0	4	5	Specialty Tier	1	4	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												
H6609	107	0	1	04	01	H6609_107_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	107	0	1	04	01	H6609_107_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	107	0	1	04	01	H6609_107_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		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												
H6609	107	0	1	04	01	H6609_107_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		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												
H6609	107	0	1	04	01	H6609_107_0	3	5	Specialty Tier	1	4	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												
H6609	107	0	1	04	01	H6609_107_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	107	0	1	04	01	H6609_107_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	107	0	1	04	01	H6609_107_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		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										2	3	
H6609	107	0	1	04	01	H6609_107_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		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										2	3	
H6609	107	0	1	04	01	H6609_107_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	108	0	1	04	01	H6609_108_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	108	0	1	04	01	H6609_108_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	108	0	1	04	01	H6609_108_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		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										2	3	
H6609	108	0	1	04	01	H6609_108_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	108	0	1	04	01	H6609_108_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	108	0	1	04	01	H6609_108_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	108	0	1	04	01	H6609_108_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	108	0	1	04	01	H6609_108_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		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										2	3	
H6609	108	0	1	04	01	H6609_108_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		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												
H6609	108	0	1	04	01	H6609_108_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		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												
H6609	109	0	1	04	01	H6609_109_0	3	5	Specialty Tier	1	3	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												
H6609	109	0	1	04	01	H6609_109_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		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												
H6609	109	0	1	04	01	H6609_109_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		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												
H6609	109	0	1	04	01	H6609_109_0	3	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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	109	0	1	04	01	H6609_109_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	110	0	1	04	01	H6609_110_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	110	0	1	04	01	H6609_110_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		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										2	3	
H6609	110	0	1	04	01	H6609_110_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	110	0	1	04	01	H6609_110_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		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										2	3	
H6609	110	0	1	04	01	H6609_110_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	110	0	1	04	01	H6609_110_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	110	0	1	04	01	H6609_110_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	110	0	1	04	01	H6609_110_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		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												
H6609	110	0	1	04	01	H6609_110_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		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												
H6609	110	0	1	04	01	H6609_110_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	112	0	1	04	01	H6609_112_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					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		260.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	112	0	1	04	01	H6609_112_0	3	5	Specialty Tier	3	4	010010	1	1		010	01		010	1				30							30			30		31														28								28														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	112	0	1	04	01	H6609_112_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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		110.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	112	0	1	04	01	H6609_112_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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	112	0	1	04	01	H6609_112_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														28								28														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	112	0	1	04	01	H6609_112_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					0.03	1.00		3.00												0.13	4.00		12.00				0.03	1.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	112	0	1	04	01	H6609_112_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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	112	0	1	04	01	H6609_112_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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		110.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	112	0	1	04	01	H6609_112_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					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		260.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	113	0	1	04	01	H6609_113_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	113	0	1	04	01	H6609_113_0	3	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	113	0	1	04	01	H6609_113_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	113	0	1	04	01	H6609_113_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		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												
H6609	113	0	1	04	01	H6609_113_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		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												
H6609	114	0	1	04	01	H6609_114_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		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										2	3	
H6609	114	0	1	04	01	H6609_114_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	114	0	1	04	01	H6609_114_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		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										2	3	
H6609	114	0	1	04	01	H6609_114_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	114	0	1	04	01	H6609_114_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	114	0	1	04	01	H6609_114_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	114	0	1	04	01	H6609_114_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		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												
H6609	114	0	1	04	01	H6609_114_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		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												
H6609	114	0	1	04	01	H6609_114_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	114	0	1	04	01	H6609_114_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	115	0	1	04	01	H6609_115_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	115	0	1	04	01	H6609_115_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		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										2	3	
H6609	115	0	1	04	01	H6609_115_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		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												
H6609	115	0	1	04	01	H6609_115_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	115	0	1	04	01	H6609_115_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		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												
H6609	115	0	1	04	01	H6609_115_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_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		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										2	3	
H6609	116	0	1	04	01	H6609_116_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	116	0	1	04	01	H6609_116_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		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										2	3	
H6609	116	0	1	04	01	H6609_116_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		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										2	3	
H6609	116	0	1	04	01	H6609_116_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	116	0	1	04	01	H6609_116_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		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												
H6609	116	0	1	04	01	H6609_116_0	3	5	Specialty Tier	1	4	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												
H6609	116	0	1	04	01	H6609_116_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	116	0	1	04	01	H6609_116_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		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												
H6609	116	0	1	04	01	H6609_116_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	116	0	1	04	01	H6609_116_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	117	0	1	04	01	H6609_117_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	117	0	1	04	01	H6609_117_0	3	5	Specialty Tier	1	4	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												
H6609	117	0	1	04	01	H6609_117_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		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												
H6609	117	0	1	04	01	H6609_117_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		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												
H6609	117	0	1	04	01	H6609_117_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	117	0	1	04	01	H6609_117_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	117	0	1	04	01	H6609_117_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	117	0	1	04	01	H6609_117_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		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										2	3	
H6609	117	0	1	04	01	H6609_117_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		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										2	3	
H6609	117	0	1	04	01	H6609_117_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	118	0	1	04	01	H6609_118_0	3	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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	118	0	1	04	01	H6609_118_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	118	0	1	04	01	H6609_118_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		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												
H6609	118	0	1	04	01	H6609_118_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		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												
H6609	118	0	1	04	01	H6609_118_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	119	0	1	04	01	H6609_119_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	119	0	1	04	01	H6609_119_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	119	0	1	04	01	H6609_119_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		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												
H6609	119	0	1	04	01	H6609_119_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		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												
H6609	119	0	1	04	01	H6609_119_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	119	0	1	04	01	H6609_119_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	119	0	1	04	01	H6609_119_0	3	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	119	0	1	04	01	H6609_119_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		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										2	3	
H6609	119	0	1	04	01	H6609_119_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		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										2	3	
H6609	119	0	1	04	01	H6609_119_0	3	5	Specialty Tier	1	4	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												
H6609	120	0	1	04	01	H6609_120_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	120	0	1	04	01	H6609_120_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	120	0	1	04	01	H6609_120_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		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												
H6609	120	0	1	04	01	H6609_120_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		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												
H6609	120	0	1	04	01	H6609_120_0	6	5	Specialty Tier	1	4	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												
H6609	120	0	1	04	01	H6609_120_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		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										2	3	
H6609	120	0	1	04	01	H6609_120_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		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										2	3	
H6609	120	0	1	04	01	H6609_120_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	120	0	1	04	01	H6609_120_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	120	0	1	04	01	H6609_120_0	6	5	Specialty Tier	3	4	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										2	3	
H6609	121	0	1	04	01	H6609_121_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	121	0	1	04	01	H6609_121_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		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										2	3	
H6609	121	0	1	04	01	H6609_121_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	121	0	1	04	01	H6609_121_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	121	0	1	04	01	H6609_121_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		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										2	3	
H6609	121	0	1	04	01	H6609_121_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	121	0	1	04	01	H6609_121_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		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												
H6609	121	0	1	04	01	H6609_121_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		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												
H6609	121	0	1	04	01	H6609_121_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	121	0	1	04	01	H6609_121_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	122	0	1	04	01	H6609_122_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	122	0	1	04	01	H6609_122_0	4	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	122	0	1	04	01	H6609_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		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										2	3	
H6609	122	0	1	04	01	H6609_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		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										2	3	
H6609	122	0	1	04	01	H6609_122_0	4	5	Specialty Tier	1	4	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												
H6609	122	0	1	04	01	H6609_122_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	122	0	1	04	01	H6609_122_0	4	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	122	0	1	04	01	H6609_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		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												
H6609	122	0	1	04	01	H6609_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		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												
H6609	122	0	1	04	01	H6609_122_0	4	5	Specialty Tier	3	4	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										2	3	
H6609	123	0	1	04	01	H6609_123_0	3	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		33.00				0.36	11.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	123	0	1	04	01	H6609_123_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		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												
H6609	123	0	1	04	01	H6609_123_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		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												
H6609	123	0	1	04	01	H6609_123_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	123	0	1	04	01	H6609_123_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	123	0	1	04	01	H6609_123_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	123	0	1	04	01	H6609_123_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		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										2	3	
H6609	123	0	1	04	01	H6609_123_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	123	0	1	04	01	H6609_123_0	3	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		33.00				0.36	11.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	123	0	1	04	01	H6609_123_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		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										2	3	
H6609	124	0	1	04	01	H6609_124_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	124	0	1	04	01	H6609_124_0	4	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	124	0	1	04	01	H6609_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		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												
H6609	124	0	1	04	01	H6609_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		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												
H6609	124	0	1	04	01	H6609_124_0	4	5	Specialty Tier	1	4	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												
H6609	124	0	1	04	01	H6609_124_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	124	0	1	04	01	H6609_124_0	4	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	124	0	1	04	01	H6609_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		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										2	3	
H6609	124	0	1	04	01	H6609_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		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										2	3	
H6609	124	0	1	04	01	H6609_124_0	4	5	Specialty Tier	3	4	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										2	3	
H6609	125	0	1	04	01	H6609_125_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	125	0	1	04	01	H6609_125_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	125	0	1	04	01	H6609_125_0	6	5	Specialty Tier	3	4	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										2	3	
H6609	125	0	1	04	01	H6609_125_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		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										2	3	
H6609	125	0	1	04	01	H6609_125_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		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										2	3	
H6609	125	0	1	04	01	H6609_125_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	125	0	1	04	01	H6609_125_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	125	0	1	04	01	H6609_125_0	6	5	Specialty Tier	1	4	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												
H6609	125	0	1	04	01	H6609_125_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		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												
H6609	125	0	1	04	01	H6609_125_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		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												
H6609	126	0	1	04	01	H6609_126_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					1.33	40.00		120.00												3.16	95.00		285.00				1.33	40.00		110.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	126	0	1	04	01	H6609_126_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					0.80	24.00		72.00												1.50	45.00		135.00				0.80	24.00		62.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	126	0	1	04	01	H6609_126_0	3	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					0.10	3.00		9.00												0.36	11.00		33.00				0.10	3.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	126	0	1	04	01	H6609_126_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														26								26														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	126	0	1	04	01	H6609_126_0	3	5	Specialty Tier	3	4	010010	1	1		010	01		010	1				30							30			30		31														26								26														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	126	0	1	04	01	H6609_126_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					0.80	24.00		72.00												1.50	45.00		135.00				0.80	24.00		62.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	126	0	1	04	01	H6609_126_0	3	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					0.10	3.00		9.00												0.36	11.00		33.00				0.10	3.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	126	0	1	04	01	H6609_126_0	3	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					0.03	1.00		3.00												0.26	8.00		24.00				0.03	1.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	126	0	1	04	01	H6609_126_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					1.33	40.00		120.00												3.16	95.00		285.00				1.33	40.00		110.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	127	0	1	04	01	H6609_127_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	127	0	1	04	01	H6609_127_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	127	0	1	04	01	H6609_127_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		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												
H6609	127	0	1	04	01	H6609_127_0	4	5	Specialty Tier	3	4	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										2	3	
H6609	127	0	1	04	01	H6609_127_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		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										2	3	
H6609	127	0	1	04	01	H6609_127_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		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										2	3	
H6609	127	0	1	04	01	H6609_127_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	127	0	1	04	01	H6609_127_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	127	0	1	04	01	H6609_127_0	4	5	Specialty Tier	1	4	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												
H6609	127	0	1	04	01	H6609_127_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		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												
H6609	128	0	1	04	01	H6609_128_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		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												
H6609	128	0	1	04	01	H6609_128_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		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												
H6609	128	0	1	04	01	H6609_128_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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	128	0	1	04	01	H6609_128_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	128	0	1	04	01	H6609_128_0	4	5	Specialty Tier	1	3	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												
H6609	129	0	1	04	01	H6609_129_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	129	0	1	04	01	H6609_129_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	129	0	1	04	01	H6609_129_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		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												
H6609	129	0	1	04	01	H6609_129_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		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												
H6609	129	0	1	04	01	H6609_129_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	129	0	1	04	01	H6609_129_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		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										2	3	
H6609	129	0	1	04	01	H6609_129_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	129	0	1	04	01	H6609_129_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	129	0	1	04	01	H6609_129_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	129	0	1	04	01	H6609_129_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		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										2	3	
H6609	130	0	1	04	01	H6609_130_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		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												
H6609	130	0	1	04	01	H6609_130_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		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												
H6609	130	0	1	04	01	H6609_130_0	3	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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	130	0	1	04	01	H6609_130_0	3	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	130	0	1	04	01	H6609_130_0	3	5	Specialty Tier	1	3	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												
H6609	131	0	1	04	01	H6609_131_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	131	0	1	04	01	H6609_131_0	3	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		27.00				0.30	9.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	131	0	1	04	01	H6609_131_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		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										2	3	
H6609	131	0	1	04	01	H6609_131_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	131	0	1	04	01	H6609_131_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	131	0	1	04	01	H6609_131_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		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												
H6609	131	0	1	04	01	H6609_131_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		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										2	3	
H6609	131	0	1	04	01	H6609_131_0	3	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		27.00				0.30	9.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	131	0	1	04	01	H6609_131_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	131	0	1	04	01	H6609_131_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		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												
H6609	132	0	1	04	01	H6609_132_0	3	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	132	0	1	04	01	H6609_132_0	3	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		33.00				0.36	11.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	132	0	1	04	01	H6609_132_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		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												
H6609	132	0	1	04	01	H6609_132_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		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												
H6609	132	0	1	04	01	H6609_132_0	3	5	Specialty Tier	1	3	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												
H6609	133	0	1	04	01	H6609_133_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	133	0	1	04	01	H6609_133_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	133	0	1	04	01	H6609_133_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	133	0	1	04	01	H6609_133_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		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										2	3	
H6609	133	0	1	04	01	H6609_133_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		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										2	3	
H6609	133	0	1	04	01	H6609_133_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	133	0	1	04	01	H6609_133_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	133	0	1	04	01	H6609_133_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	133	0	1	04	01	H6609_133_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		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												
H6609	133	0	1	04	01	H6609_133_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		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												
H6609	134	0	1	04	01	H6609_134_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	134	0	1	04	01	H6609_134_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		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										2	3	
H6609	134	0	1	04	01	H6609_134_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		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										2	3	
H6609	134	0	1	04	01	H6609_134_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	134	0	1	04	01	H6609_134_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	134	0	1	04	01	H6609_134_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	134	0	1	04	01	H6609_134_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		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												
H6609	134	0	1	04	01	H6609_134_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		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												
H6609	134	0	1	04	01	H6609_134_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	134	0	1	04	01	H6609_134_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	135	0	1	04	01	H6609_135_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	135	0	1	04	01	H6609_135_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	135	0	1	04	01	H6609_135_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		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										2	3	
H6609	135	0	1	04	01	H6609_135_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		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										2	3	
H6609	135	0	1	04	01	H6609_135_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	135	0	1	04	01	H6609_135_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	135	0	1	04	01	H6609_135_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	135	0	1	04	01	H6609_135_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		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												
H6609	135	0	1	04	01	H6609_135_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		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												
H6609	135	0	1	04	01	H6609_135_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	136	0	1	04	01	H6609_136_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	136	0	1	04	01	H6609_136_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	136	0	1	04	01	H6609_136_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	136	0	1	04	01	H6609_136_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		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												
H6609	136	0	1	04	01	H6609_136_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		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										2	3	
H6609	136	0	1	04	01	H6609_136_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	136	0	1	04	01	H6609_136_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	136	0	1	04	01	H6609_136_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	136	0	1	04	01	H6609_136_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		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										2	3	
H6609	136	0	1	04	01	H6609_136_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		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												
H6609	137	0	1	04	01	H6609_137_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		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										2	3	
H6609	137	0	1	04	01	H6609_137_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	137	0	1	04	01	H6609_137_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		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										2	3	
H6609	137	0	1	04	01	H6609_137_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	137	0	1	04	01	H6609_137_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	137	0	1	04	01	H6609_137_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	137	0	1	04	01	H6609_137_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		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												
H6609	137	0	1	04	01	H6609_137_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		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												
H6609	137	0	1	04	01	H6609_137_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	137	0	1	04	01	H6609_137_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	138	0	1	04	01	H6609_138_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	138	0	1	04	01	H6609_138_0	3	5	Specialty Tier	3	4	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										2	3	
H6609	138	0	1	04	01	H6609_138_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		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										2	3	
H6609	138	0	1	04	01	H6609_138_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	138	0	1	04	01	H6609_138_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	138	0	1	04	01	H6609_138_0	3	5	Specialty Tier	1	4	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												
H6609	138	0	1	04	01	H6609_138_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		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												
H6609	138	0	1	04	01	H6609_138_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		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												
H6609	138	0	1	04	01	H6609_138_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	138	0	1	04	01	H6609_138_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		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										2	3	
H6609	140	0	1	04	01	H6609_140_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	140	0	1	04	01	H6609_140_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	140	0	1	04	01	H6609_140_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		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												
H6609	140	0	1	04	01	H6609_140_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		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												
H6609	140	0	1	04	01	H6609_140_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		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										2	3	
H6609	140	0	1	04	01	H6609_140_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	140	0	1	04	01	H6609_140_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	140	0	1	04	01	H6609_140_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		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										2	3	
H6609	140	0	1	04	01	H6609_140_0	4	5	Specialty Tier	3	4	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										2	3	
H6609	140	0	1	04	01	H6609_140_0	4	5	Specialty Tier	1	4	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												
H6622	001	0	1	01	01	H6622_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_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		45.00				0.50	15.00		0.00				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	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		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												
H6622	001	0	1	01	01	H6622_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		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												
H6622	001	0	1	01	01	H6622_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		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										2	3	
H6622	001	0	1	01	01	H6622_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	001	0	1	01	01	H6622_001_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		45.00				0.50	15.00		0.00				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	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		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										2	3	
H6622	001	0	1	01	01	H6622_001_0	3	5	Specialty Tier	3	4	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										2	3	
H6622	001	0	1	01	01	H6622_001_0	3	5	Specialty Tier	1	4	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												
H6622	002	0	1	01	01	H6622_002_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		18.00				0.20	6.00		0.00				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	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		45.00				0.50	15.00		0.00				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	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		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												
H6622	002	0	1	01	01	H6622_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		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												
H6622	002	0	1	01	01	H6622_002_0	3	5	Specialty Tier	1	4	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												
H6622	002	0	1	01	01	H6622_002_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	002	0	1	01	01	H6622_002_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		45.00				0.50	15.00		0.00				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	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		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										2	3	
H6622	002	0	1	01	01	H6622_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		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										2	3	
H6622	002	0	1	01	01	H6622_002_0	3	5	Specialty Tier	3	4	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										2	3	
H6622	003	0	1	01	01	H6622_003_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		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												
H6622	003	0	1	01	01	H6622_003_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	003	0	1	01	01	H6622_003_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		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												
H6622	003	0	1	01	01	H6622_003_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		18.00				0.20	6.00		0.00				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	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		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										2	3	
H6622	003	0	1	01	01	H6622_003_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		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										2	3	
H6622	003	0	1	01	01	H6622_003_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	003	0	1	01	01	H6622_003_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_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		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										2	3	
H6622	004	0	1	01	01	H6622_004_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												
H6622	004	0	1	01	01	H6622_004_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_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		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												
H6622	004	0	1	01	01	H6622_004_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	004	0	1	01	01	H6622_004_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_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	
H6622	004	0	1	01	01	H6622_004_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	004	0	1	01	01	H6622_004_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		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										2	3	
H6622	004	0	1	01	01	H6622_004_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		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												
H6622	005	0	1	01	01	H6622_005_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	005	0	1	01	01	H6622_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		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										2	3	
H6622	005	0	1	01	01	H6622_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	005	0	1	01	01	H6622_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	
H6622	005	0	1	01	01	H6622_005_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	005	0	1	01	01	H6622_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		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												
H6622	005	0	1	01	01	H6622_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		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												
H6622	005	0	1	01	01	H6622_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		30.00				0.33	10.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	005	0	1	01	01	H6622_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												
H6622	005	0	1	01	01	H6622_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		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										2	3	
H6622	007	0	1	01	01	H6622_007_0	3	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		24.00				0.26	8.00		0.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	3	5	Specialty Tier	1	3	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												
H6622	007	0	1	01	01	H6622_007_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		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												
H6622	007	0	1	01	01	H6622_007_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		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												
H6622	007	0	1	01	01	H6622_007_0	3	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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	001	0	1	04	01	H6743_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		190.00																					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												
H6743	001	0	1	04	01	H6743_001_0	5	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31					737.72	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	001	0	1	04	01	H6743_001_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		90.00																					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												
H6743	001	0	1	04	01	H6743_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.66	20.00		40.00																					.66	20.00		40.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	001	0	1	04	01	H6743_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.33	10.00		20.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	001	0	1	04	01	H6743_001_0	5	6	Vaccines	1	4	010010	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, Vaccines												
H6743	003	0	1	04	01	H6743_003_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		30.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	003	0	1	04	01	H6743_003_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.20	6.00		12.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	003	0	1	04	01	H6743_003_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		80.00																					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												
H6743	003	0	1	04	01	H6743_003_0	6	6	Vaccines	1	4	010010	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, Vaccines												
H6743	003	0	1	04	01	H6743_003_0	6	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31					264.04	29		29																					29		29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	003	0	1	04	01	H6743_003_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.83	85.00		170.00																					2.83	85.00		170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	004	0	1	04	01	H6743_004_0	6	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		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	004	0	1	04	01	H6743_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		20.00																					.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	004	0	1	04	01	H6743_004_0	6	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31					454.57	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	004	0	1	04	01	H6743_004_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.50	75.00		150.00																					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												
H6743	004	0	1	04	01	H6743_004_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.16	35.00		70.00																					1.16	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	004	0	1	04	01	H6743_004_0	6	6	Vaccines	1	4	010010	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, Vaccines												
H6743	005	0	1	04	01	H6743_005_0	6	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31					541.39	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	005	0	1	04	01	H6743_005_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.50	75.00		150.00																					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												
H6743	005	0	1	04	01	H6743_005_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.16	35.00		70.00																					1.16	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	005	0	1	04	01	H6743_005_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		20.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	005	0	1	04	01	H6743_005_0	6	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		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	005	0	1	04	01	H6743_005_0	6	6	Vaccines	1	4	010010	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, Vaccines												
H6743	007	0	1	04	01	H6743_007_0	5	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31					554.01	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	007	0	1	04	01	H6743_007_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		190.00																					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												
H6743	007	0	1	04	01	H6743_007_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		90.00																					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												
H6743	007	0	1	04	01	H6743_007_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.66	20.00		40.00																					.66	20.00		40.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	007	0	1	04	01	H6743_007_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.33	10.00		20.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	007	0	1	04	01	H6743_007_0	5	6	Vaccines	1	4	010010	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, Vaccines												
H6743	014	0	1	04	01	H6743_014_0	7	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31					575.15	29		29																					29		29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	014	0	1	04	01	H6743_014_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		190.00																					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												
H6743	014	0	1	04	01	H6743_014_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		90.00																					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												
H6743	014	0	1	04	01	H6743_014_0	7	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		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	014	0	1	04	01	H6743_014_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.33	10.00		20.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	014	0	1	04	01	H6743_014_0	7	6	Vaccines	1	4	010010	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, Vaccines												
H6743	016	0	1	04	01	H6743_016_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.20	6.00		12.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	016	0	1	04	01	H6743_016_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		30.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	016	0	1	04	01	H6743_016_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		80.00																					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												
H6743	016	0	1	04	01	H6743_016_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.83	85.00		170.00																					2.83	85.00		170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	016	0	1	04	01	H6743_016_0	6	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31					247.59	29		29																					29		29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	016	0	1	04	01	H6743_016_0	6	6	Vaccines	1	4	010010	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, Vaccines												
H6743	017	0	1	04	01	H6743_017_0	6	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		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	017	0	1	04	01	H6743_017_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		20.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	017	0	1	04	01	H6743_017_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.16	35.00		70.00																					1.16	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	017	0	1	04	01	H6743_017_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.50	75.00		150.00																					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												
H6743	017	0	1	04	01	H6743_017_0	6	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31					279.71	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	017	0	1	04	01	H6743_017_0	6	6	Vaccines	1	4	010010	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, Vaccines												
H6745	001	0	1	01	01	H6745_001_0	8	2	Non-Preferred Generic	1	4	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, Specialty Tier												
H6745	001	0	1	01	01	H6745_001_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, Specialty Tier												
H6745	001	0	1	01	01	H6745_001_0	8	4	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31						33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H6745	001	0	1	01	01	H6745_001_0	8	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, Specialty Tier												
H6745	003	0	1	01	01	H6745_003_0	5	3	Preferred Brand	1	2	000001	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					74.38	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6745	003	0	1	01	01	H6745_003_0	5	2	Non-Preferred Generic	1	2	000100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					10.42	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6745	003	0	1	01	01	H6745_003_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												
H6745	003	0	1	01	01	H6745_003_0	5	4	Non-Preferred Brand	1	2	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					63.18	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6745	003	0	1	01	01	H6745_003_0	5	5	Specialty Tier	1	2	100001	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31						25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	001	0	1	01	01	H6750_001_0	8	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	1.50	45.00		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												
H6750	001	0	1	01	01	H6750_001_0	8	2	Non-Preferred Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	0.33	10.00		30.00																					.22	6.66	13.33	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	001	0	1	01	01	H6750_001_0	8	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		90				1	30	60	90				30		31	0.13	4.00		12.00																					.08	2.66	5.33	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	001	0	1	01	01	H6750_001_0	8	1	Preferred Generic	3	4	001000	3	2	110		01	111		1	30		90				1	30	60	90				30		31	.13	4.00		12.00																					.08	2.66	5.33	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H6750	001	0	1	01	01	H6750_001_0	8	2	Non-Preferred Generic	3	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	.33	10.00		30.00																					.22	6.66	13.33	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H6750	001	0	1	01	01	H6750_001_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31						33		33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	001	0	1	01	01	H6750_001_0	8	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	3.16	95.00		285.00																					2.11	63.33	126.66	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	002	0	1	01	01	H6750_002_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31						33		33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	002	0	1	01	01	H6750_002_0	8	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	3.16	95.00		285.00																					2.11	63.33	126.66	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	002	0	1	01	01	H6750_002_0	8	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	1.50	45.00		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												
H6750	002	0	1	01	01	H6750_002_0	8	2	Non-Preferred Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	0.33	10.00		30.00																					.22	6.66	13.33	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	002	0	1	01	01	H6750_002_0	8	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		90				1	30	60	90				30		31	0.13	4.00		12.00																					.08	2.66	5.33	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6751	001	0	1	48	05	H6751_001_0	4	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	4	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	002	0	1	04	01	H6786_002_0	15	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6786	002	0	1	04	01	H6786_002_0	15	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6786	002	0	1	04	01	H6786_002_0	15	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6786	002	0	1	04	01	H6786_002_0	15	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.93	28.00	56.00	84.00					.76	23.00	46.00	69.00					.76	23.00	46.00	46.00																		28.00				.82	28.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6786	002	0	1	04	01	H6786_002_0	15	5	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, Specialty Tier, Select Care Drugs												
H6786	002	0	1	04	01	H6786_002_0	15	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		2.00				.05	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6801	002	0	1	01	01	H6801_002_0	14	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	14	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	14	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	14	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	14	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	14	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.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	14	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6801	006	0	1	02	01	H6801_006_0	14	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	14	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	14	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	14	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	14	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	14	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6801	006	0	1	02	01	H6801_006_0	14	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6815	001	0	1	01	01	H6815_001_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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	70.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	001	0	1	01	01	H6815_001_0	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					0.27	8.00	16.00	24.00												0.50	15.00	30.00	45.00				0.27	8.00	16.00	16.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	001	0	1	01	01	H6815_001_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.27	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.27	8.00	16.00	24.00				0.10	3.00	6.00	6.00				8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	001	0	1	01	01	H6815_001_0	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	213.00				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	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	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	001	0	1	01	01	H6815_001_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	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					1.17	35.00	70.00	105.00												1.50	45.00	90.00	135.00				1.17	35.00	70.00	70.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	002	0	1	01	01	H6815_002_0	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					0.27	8.00	16.00	24.00												0.50	15.00	30.00	45.00				0.27	8.00	16.00	16.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	002	0	1	01	01	H6815_002_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.27	8.00	16.00	24.00					0.10	3.00	6.00	9.00												0.27	8.00	16.00	24.00				0.10	3.00	6.00	6.00				8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	002	0	1	01	01	H6815_002_0	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	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	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		34														33	33	33						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	3	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.17	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.17	95.00	190.00	285.00				2.83	85.00	170.00	213.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6859	001	0	1	01	01	H6859_001_0	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		54.00				0.60	18.00		0.00				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	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		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										2	3	
H6859	001	0	1	01	01	H6859_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		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										2	3	
H6859	001	0	1	01	01	H6859_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	001	0	1	01	01	H6859_001_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	001	0	1	01	01	H6859_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		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												
H6859	001	0	1	01	01	H6859_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		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												
H6859	001	0	1	01	01	H6859_001_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	001	0	1	01	01	H6859_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		18.00				0.20	6.00		0.00				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	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		54.00				0.60	18.00		0.00				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	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		54.00				0.60	18.00		0.00				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	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		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										2	3	
H6859	003	0	1	01	01	H6859_003_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		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										2	3	
H6859	003	0	1	01	01	H6859_003_0	3	5	Specialty Tier	3	4	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										2	3	
H6859	003	0	1	01	01	H6859_003_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		18.00				0.20	6.00		0.00				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	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		54.00				0.60	18.00		0.00				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	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		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												
H6859	003	0	1	01	01	H6859_003_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		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												
H6859	003	0	1	01	01	H6859_003_0	3	5	Specialty Tier	1	4	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												
H6859	003	0	1	01	01	H6859_003_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	004	0	1	01	01	H6859_004_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				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	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		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												
H6859	004	0	1	01	01	H6859_004_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		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												
H6859	004	0	1	01	01	H6859_004_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	004	0	1	01	01	H6859_004_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		54.00				0.60	18.00		0.00				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	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		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										2	3	
H6859	004	0	1	01	01	H6859_004_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		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										2	3	
H6859	004	0	1	01	01	H6859_004_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	007	0	1	01	01	H6859_007_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	007	0	1	01	01	H6859_007_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	007	0	1	01	01	H6859_007_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		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												
H6859	007	0	1	01	01	H6859_007_0	3	5	Specialty Tier	3	4	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										2	3	
H6859	007	0	1	01	01	H6859_007_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		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										2	3	
H6859	007	0	1	01	01	H6859_007_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		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										2	3	
H6859	007	0	1	01	01	H6859_007_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6859	007	0	1	01	01	H6859_007_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		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												
H6859	007	0	1	01	01	H6859_007_0	3	5	Specialty Tier	1	4	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												
H6859	007	0	1	01	01	H6859_007_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6864	001	0	1	02	01	H6864_001_0	13	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	30	60	90				2			90				30		31	.06	2.00	4.00	6.00																								4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6864	001	0	1	02	01	H6864_001_0	13	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	30	60	90				2			90				30		31					65.83	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6864	001	0	1	02	01	H6864_001_0	13	3	Preferred Brand	1	2	000001	1	1	111		01	100		1	30	60	90				2			90				30		31					53.99	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6864	001	0	1	02	01	H6864_001_0	13	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	30	60	90				2			90				30		31	.33	10.00	20.00	30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6864	001	0	1	02	01	H6864_001_0	13	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	30	60	90				2			90				30		31					582.74	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6923	001	0	1	01	01	H6923_001_0	8	3	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	135.00												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												
H6923	001	0	1	01	01	H6923_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.40	12.00	24.00	36.00					.26	8.00	16.00	24.00												.40	12.00	24.00	36.00				.26	8.00	16.00	24.00					12.00			.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6923	001	0	1	01	01	H6923_001_0	8	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6923	001	0	1	01	01	H6923_001_0	8	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													46.48	50	50	50					39.79	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6923	001	0	1	01	01	H6923_001_0	8	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6923	005	0	1	01	01	H6923_005_0	8	1	Preferred Generic	1	4	001000	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												
H6923	005	0	1	01	01	H6923_005_0	8	2	Non-Preferred Generic	1	4	000100	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	24.00																			8.00			.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H6923	005	0	1	01	01	H6923_005_0	8	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					39.24	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H6923	005	0	1	01	01	H6923_005_0	8	3	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	135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H6951	002	0	1	04	01	H6951_002_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	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	6	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	002	0	1	04	01	H6951_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	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	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	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	6	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	6	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	6	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	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	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	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	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	6	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	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		6.00																		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	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		285.00																		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	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		135.00																		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	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		33.00																		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	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					665.40	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6974	001	0	1	48	05	H6974_001_0	5	4	Non-Medicare OTC Drugs	1	4	010010			110		01			1	30		90				1							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			
H6974	001	0	1	48	05	H6974_001_0	5	3	Non-Medicare Rx Drugs	1	4	010010			110		01			1	30		90				1							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			
H6974	001	0	1	48	05	H6974_001_0	5	2	Brand Drugs	1	4	000010			110		01			1	30		90				1							30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00			0.00	0.00			
H6974	001	0	1	48	05	H6974_001_0	5	1	Generic Drugs	1	4	010000			110		01			1	30		90				1							30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00			0.00	0.00			
H6988	001	0	1	01	01	H6988_001_0	6	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	0.07	2.00		6.00																								5.00																		2.00				0.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.17	35.00		105.00																								87.50																		35.00				1.13	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.83	85.00		255.00																								212.50																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	6	4	Specialty Tier	1	4	110001	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												
H7006	001	0	1	04	01	H7006_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.50	75.00		150.00																					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												
H7006	001	0	1	04	01	H7006_001_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.16	35.00		70.00																					1.16	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	001	0	1	04	01	H7006_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		20.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	001	0	1	04	01	H7006_001_0	6	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		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	001	0	1	04	01	H7006_001_0	6	6	Vaccines	1	4	010010	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, Vaccines												
H7006	001	0	1	04	01	H7006_001_0	6	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31					608.75	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	003	0	1	04	01	H7006_003_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		30.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	003	0	1	04	01	H7006_003_0	7	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		80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	003	0	1	04	01	H7006_003_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.83	85.00		170.00																					2.83	85.00		170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	003	0	1	04	01	H7006_003_0	7	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31					607.25	29		29																					29		29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	003	0	1	04	01	H7006_003_0	7	6	Vaccines	1	4	010010	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, Vaccines												
H7006	003	0	1	04	01	H7006_003_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.20	6.00		12.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	005	0	1	04	01	H7006_005_0	6	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31					682.63	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	005	0	1	04	01	H7006_005_0	6	6	Vaccines	1	4	010010	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, Vaccines												
H7006	005	0	1	04	01	H7006_005_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		190.00																					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												
H7006	005	0	1	04	01	H7006_005_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		90.00																					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												
H7006	005	0	1	04	01	H7006_005_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.66	20.00		40.00																					.66	20.00		40.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	005	0	1	04	01	H7006_005_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.33	10.00		20.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7020	001	0	1	01	01	H7020_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		9.00																		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	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		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7020	001	0	1	01	01	H7020_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		135.00																		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	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		255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7020	001	0	1	01	01	H7020_001_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					548.26	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	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		9.00																		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	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		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7115	001	0	1	01	01	H7115_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	2.83	85.00	170.00	212.50																								170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	5	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	112.50																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.17	5.00	10.00	12.50																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	5	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												
H7115	001	0	1	01	01	H7115_001_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31						30	30	30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	5	1	Preferred Generic	3	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										1		
H7115	001	0	1	01	01	H7115_001_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.17	5.00	10.00	12.50																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7149	001	0	1	01	01	H7149_001_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													46.88	50	50	50					43.23	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	4	3	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	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												
H7149	001	0	1	01	01	H7149_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.40	12.00	24.00	36.00					.30	9.00	18.00	27.00					.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	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.30	9.00	18.00	27.00					.13	4.00	8.00	12.00					.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	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	5	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													51.18	50	50	50					45.83	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	5	3	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	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												
H7149	004	0	1	01	01	H7149_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	30.00					.23	7.00	14.00	21.00					.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	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.23	7.00	14.00	21.00					.10	3.00	6.00	9.00					.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	005	0	1	01	01	H7149_005_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	005	0	1	01	01	H7149_005_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													37.20	50	50	50					35.14	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	005	0	1	01	01	H7149_005_0	4	3	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	112.50					1.50	45.00	90.00	112.50					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												
H7149	005	0	1	01	01	H7149_005_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.23	7.00	14.00	17.50					.10	3.00	6.00	7.50					.10	3.00	6.00	7.50																			7.00			.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	005	0	1	01	01	H7149_005_0	4	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7149	005	0	1	01	01	H7149_005_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7172	001	0	1	48	05	H7172_001_0	2	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/OTC Drugs	1	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	2	3	Non-Medicare Rx/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/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	2	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/OTC Drugs	1	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	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												
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	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												
H7187	003	0	1	01	01	H7187_003_0	2	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							275.00				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	2	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							125.00				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	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	003	0	1	01	01	H7187_003_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					717.00	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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	009	0	1	01	01	H7187_009_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	009	0	1	01	01	H7187_009_0	2	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							125.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					708.00	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	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	010	0	1	01	01	H7187_010_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	010	0	1	01	01	H7187_010_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	010	0	1	01	01	H7187_010_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	010	0	1	01	01	H7187_010_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	010	0	1	01	01	H7187_010_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					706.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	011	0	1	01	01	H7187_011_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	011	0	1	01	01	H7187_011_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	011	0	1	01	01	H7187_011_0	2	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	011	0	1	01	01	H7187_011_0	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	011	0	1	01	01	H7187_011_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					685.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7200	006	0	1	01	01	H7200_006_0	11	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.16	5.00	10.00	15.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	006	0	1	01	01	H7200_006_0	11	2	Non-Preferred Generic	1	3	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	30.00					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	006	0	1	01	01	H7200_006_0	11	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.70	21.00	42.00	63.00					.70	21.00	42.00	63.00					.70	21.00	63.00	63.00																		21.00				.61	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	006	0	1	01	01	H7200_006_0	11	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	210.00	210.00																		75.00				2.20	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	006	0	1	01	01	H7200_006_0	11	5	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, Specialty Tier, Select Care Drugs												
H7200	006	0	1	01	01	H7200_006_0	11	6	Select Care Drugs	1	3	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												
H7200	007	0	1	01	01	H7200_007_0	12	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.23	7.00	14.00	21.00					.06	2.00	4.00	6.00					.06	2.00	4.00	4.00																		7.00				.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_007_0	12	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.00	30.00	60.00	90.00					.83	25.00	50.00	75.00					.83	25.00	50.00	50.00																		30.00				.88	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_007_0	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_007_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_007_0	12	5	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, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_007_0	12	6	Select Care Drugs	1	3	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												
H7220	003	0	1	01	01	H7220_003_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.20	6.00		18.00																					.20	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	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.50	15.00		44.00																					.50	15.00		44.00																		15.00				.45	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	003	0	1	01	01	H7220_003_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		126.00																					1.50	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	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.17	95.00		266.00																					3.17	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	9	5	Specialty Tier	1	4	100000	1	1	010		10	010		1	30							31							29	31					789.18	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.50	15.00		42.00																					.50	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	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.20	6.00		16.00																					.20	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	9	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.40	42.00		118.00																					1.40	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	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.17	95.00		266.00																					3.17	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	9	5	Specialty Tier	1	4	100000	1	1	010		10	010		1	30							30							29	31					789.18	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		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		
H7245	001	0	1	01	01	H7245_001_0	12	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00												0.30	9.00	18.00	27.00				0.13	4.00	8.00	12.00				9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	12	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					0.30	9.00	18.00	27.00												0.50	15.00	30.00	45.00				0.30	9.00	18.00	27.00				15.00				0.44	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	12	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	12	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												
H7245	001	0	1	01	01	H7245_001_0	12	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34													70.48	33							70.48	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	12	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	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					0.30	9.00	18.00	27.00												0.50	15.00	30.00	45.00				0.30	9.00	18.00	27.00				15.00				0.44	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									0.30	9.00	18.00	27.00					0.13	4.00	8.00	12.00												0.30	9.00	18.00	27.00				0.13	4.00	8.00	12.00				9.00				0.26	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	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	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													70.48	33							70.48	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	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												
H7245	003	0	1	01	01	H7245_003_0	7	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.30	9.00	18.00	27.00					.10	3.00	6.00	9.00												.30	9.00	18.00	27.00				.10	3.00	6.00	9.00				9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_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	15.00	30.00	45.00					.26	8.00	16.00	24.00												.50	15.00	30.00	45.00				.26	8.00	16.00	24.00				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	7	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	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									2.83	85.00	170.00	255.00					2.83	85.00	170.00	255.00												2.83	85.00	170.00	255.00				2.83	85.00	170.00	255.00				85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	7	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34													70.48	33							70.48	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	7	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	13	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.30	9.00	18.00	27.00					.10	3.00	6.00	9.00												.30	9.00	18.00	27.00				.10	3.00	6.00	9.00				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	13	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					0.26	8.00	16.00	24.00												.50	15.00	30.00	45.00				.26	8.00	16.00	24.00				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	13	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34													70.48	33							70.48	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	13	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									2.83	85.00	170.00	255.00					2.83	85.00	170.00	255.00												2.83	85.00	170.00	255.00				2.83	85.00	170.00	255.00				85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	004	0	1	02	01	H7245_004_0	13	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.16	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	13	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												
H7301	002	0	1	04	01	H7301_002_0	7	1	Preferred Generic	1	4	001000	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												
H7301	002	0	1	04	01	H7301_002_0	7	4	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					35.59	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	7	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31					1.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	7	3	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	135.00																			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	7	2	Non-Preferred Generic	1	4	000100	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	30.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00					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												
H7301	006	0	1	04	01	H7301_006_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.26	8.00	16.00	24.00					.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			8.00			0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	5	3	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	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												
H7301	006	0	1	04	01	H7301_006_0	5	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	5	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7301	006	0	1	04	01	H7301_006_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													50.39	50	50	50					47.96	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	5	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7301	007	0	1	04	01	H7301_007_0	5	3	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	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												
H7301	007	0	1	04	01	H7301_007_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													50.39	50	50	50					47.96	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	5	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.26	8.00	16.00	24.00					.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			8.00			0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00					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												
H7301	008	0	1	04	01	H7301_008_0	4	3	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	112.50					1.50	45.00	90.00	112.50					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												
H7301	008	0	1	04	01	H7301_008_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.23	7.00	14.00	17.50					.10	3.00	6.00	7.50					.10	3.00	6.00	7.50																			7.00			.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	008	0	1	04	01	H7301_008_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	008	0	1	04	01	H7301_008_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													39.18	50	50	50					37.11	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	008	0	1	04	01	H7301_008_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	008	0	1	04	01	H7301_008_0	4	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.13	4.00	8.00	10.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7419	001	0	1	48	05	H7419_001_0	4	1	Generic Drugs	1	4	010000			111		01	111		1	31	60	90				1	30	60	90				31		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			
H7419	001	0	1	48	05	H7419_001_0	4	3	Non-Medicare OTC Drugs	1	4	010010			111		01	111		1	31	60	90				1	31	60	90				31		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			
H7419	001	0	1	48	05	H7419_001_0	4	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 OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7542	001	0	1	48	05	H7542_001_0	3	1	Generic Drugs	1	4	010000			111		01	111		1	30	60	90				2	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	2.65	0.00	2.65	0.00	2.65	0.00	2.65			
H7542	001	0	1	48	05	H7542_001_0	3	4	Non-Medicare OTC Drugs	1	4	010010			111		01	111		1	30	60	90				2	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	3.40	3.40	3.40	3.40	3.40	3.40	3.40	3.40			
H7542	001	0	1	48	05	H7542_001_0	3	3	Non-Medicare Rx Drugs	1	4	010010			111		01	111		1	30	60	90				2	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	3.40	3.40	3.40	3.40	3.40	3.40	3.40	3.40			
H7542	001	0	1	48	05	H7542_001_0	3	2	Brand Drugs	1	4	000010			111		01	111		1	30	60	90				2	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
H7678	001	0	1	01	01	H7678_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												
H7678	001	0	1	01	01	H7678_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												
H7678	001	0	1	01	01	H7678_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												
H7678	001	0	1	01	01	H7678_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												
H7678	001	0	1	01	01	H7678_001_0	9	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		
H7680	001	0	1	01	01	H7680_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	120.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	001	0	1	01	01	H7680_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	.33	10.00	20.00	30.00																					.33	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	001	0	1	01	01	H7680_001_0	9	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	15.00																					.16	5.00	10.00	10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	001	0	1	01	01	H7680_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	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	270.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	001	0	1	01	01	H7680_001_0	9	5	Specialty Tier	1	4	000010	1	1	010		10	010		1	30							30							10	31					600.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_002_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_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	.13	4.00	8.00	12.00																					.05	1.50	3.00	3.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_002_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.00	30.00	60.00	90.00																					1.33	40.00	80.00	80.00																		30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_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	2.00	60.00	120.00	180.00																					2.83	85.00	170.00	170.00																		60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_002_0	9	5	Specialty Tier	1	4	000010	1	1	010		10	010		1	30							30							10	31					600.00	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_002_0	9	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		
H7680	002	0	1	01	01	H7680_002_0	9	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.13	4.00	8.00	12.00																					0.05	1.50	3.00	3.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7728	002	0	1	04	01	H7728_002_0	15	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	15	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.83	25.00	50.00	75.00					.66	20.00	40.00	60.00					.66	20.00	40.00	40.00																		25.00				.73	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	15	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	15	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	15	5	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, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	15	6	Select Care Drugs	1	3	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												
H7787	001	0	1	04	01	H7787_001_0	3	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												
H7787	001	0	1	04	01	H7787_001_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.13	4.00	8.00	12.00																					0.13	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_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		120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	3	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					513.01	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	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		33.00																		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		6.00																		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	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		135.00																		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	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		285.00																		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					530.18	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7844	001	0	1	48	05	H7844_001_0	4	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/OTC Drugs	1	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
H7844	001	0	1	48	05	H7844_001_0	4	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/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7844	001	0	1	48	05	H7844_001_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		01	010		1	31							31						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			
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, Non-Medicare Rx/OTC Drugs	1	0.00	2.65	0.00	2.65			0.00	2.65			
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, Non-Medicare Rx/OTC Drugs	1	0.00	6.60	0.00	6.60			0.00	6.60			
H7885	001	0	1	48	05	H7885_001_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01			1	31		93				1							31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	2	1	Generic Drugs	1	4	010000			110		01	110		1	31		90				1	31		90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx 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	2	2	Brand Drugs	1	4	000010			110		01	110		1	31		90				1	31		90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx 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	2	3	Non-Medicare Rx Drugs	1	4	010010			010		01	010		1	31							31						31		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			
H7890	001	0	1	48	05	H7890_001_0	2	4	Non-Medicare OTC Drugs	1	4	010010			010		01	010		1	31							31						31		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			
H7903	001	0	1	01	01	H7903_001_0	12	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.12	35.00	70.00	87.50																					1.12	35.00	70.00	70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7903	001	0	1	01	01	H7903_001_0	12	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.32	10.00	20.00	25.00																					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												
H7903	001	0	1	01	01	H7903_001_0	12	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.06	2.00	4.00	5.00																					0.06	2.00	4.00	4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7903	001	0	1	01	01	H7903_001_0	12	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					1223.65	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7903	001	0	1	01	01	H7903_001_0	12	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					94.32	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7908	001	0	1	01	01	H7908_001_0	6	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7908	001	0	1	01	01	H7908_001_0	6	3	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	135.00												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												
H7908	001	0	1	01	01	H7908_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.26	8.00	16.00	24.00					.13	4.00	8.00	12.00												.26	8.00	16.00	24.00				.13	4.00	8.00	12.00					8.00			.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7908	001	0	1	01	01	H7908_001_0	6	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7908	001	0	1	01	01	H7908_001_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													35.51	50	50	50					32.38	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.20	6.00	12.00	15.00																					.20	6.00	12.00	15.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	7	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.00	30.00	60.00	75.00																					1.00	30.00	60.00	75.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	7	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.66	50.00	100.00	125.00																					1.66	50.00	100.00	125.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	009	0	1	04	01	H7917_009_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	7	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.66	50.00	100.00	125.00																					1.66	50.00	100.00	125.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	7	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.00	30.00	60.00	75.00																					1.00	30.00	60.00	75.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.20	6.00	12.00	15.00																					.20	6.00	12.00	15.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	010	0	1	04	01	H7917_010_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.20	6.00	12.00	15.00																					.20	6.00	12.00	15.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	7	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.00	30.00	60.00	75.00																					1.00	30.00	60.00	75.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	7	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.66	50.00	100.00	125.00																					1.66	50.00	100.00	125.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	011	0	1	04	01	H7917_011_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.20	6.00	12.00	15.00																					.20	6.00	12.00	15.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	7	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.00	30.00	60.00	75.00																					1.00	30.00	60.00	75.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	7	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.66	50.00	100.00	125.00																					1.66	50.00	100.00	125.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	012	0	1	04	01	H7917_012_0	8	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.17	65.00	130.00	162.50																					2.17	65.00	130.00	162.50																		65.00				2.10	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.00	30.00	60.00	75.00																					1.00	30.00	60.00	75.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.20	6.00	12.00	15.00																					.20	6.00	12.00	15.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8	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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	013	0	1	04	01	H7917_013_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.20	6.00	12.00	15.00																					.20	6.00	12.00	15.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	8	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.00	30.00	60.00	75.00																					1.00	30.00	60.00	75.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	8	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.17	65.00	130.00	162.50																					2.17	65.00	130.00	162.50																		65.00				2.10	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	8	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	8	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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	014	0	1	04	01	H7917_014_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.20	6.00	12.00	15.00																					.20	6.00	12.00	15.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	8	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.00	30.00	60.00	75.00																					1.00	30.00	60.00	75.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	8	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.17	65.00	130.00	162.50																					2.17	65.00	130.00	162.50																		65.00				2.10	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	8	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	8	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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	015	0	1	04	01	H7917_015_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.20	6.00	12.00	15.00																					.20	6.00	12.00	15.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	8	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.00	30.00	60.00	75.00																					1.00	30.00	60.00	75.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	8	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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	015	0	1	04	01	H7917_015_0	8	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	8	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.17	65.00	130.00	162.50																					2.17	65.00	130.00	162.50																		65.00				2.10	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_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	7.50																					.10	3.00	6.00	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	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	30.00																					.40	12.00	24.00	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	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_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	7.50																					.10	3.00	6.00	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	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	7.50																					.10	3.00	6.00	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	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	30.00																					.40	12.00	24.00	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	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	032	0	1	04	01	H7917_032_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	032	0	1	04	01	H7917_032_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	7.50																					.10	3.00	6.00	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	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	30.00																					.40	12.00	24.00	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	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_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	7.50																					.10	3.00	6.00	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	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	30.00																					.40	12.00	24.00	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	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_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	7.50																					.10	3.00	6.00	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	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7949	001	0	1	01	01	H7949_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7949	001	0	1	01	01	H7949_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																															135.00							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7949	001	0	1	01	01	H7949_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																															285.00							275.00				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	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					781.00	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	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.06	2.00		6.00																															6.00							4.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7949	001	0	1	01	01	H7949_001_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																															24.00							16.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7960	001	0	1	01	01	H7960_001_0	8	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																					.13	4.00	8.00	8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	001	0	1	01	01	H7960_001_0	8	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																					.33	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	001	0	1	01	01	H7960_001_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												
H7960	001	0	1	01	01	H7960_001_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	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	001	0	1	01	01	H7960_001_0	8	5	Specialty Tier	1	4	100101	1	1	111		01	010		1	30	60	90				1	30						30		31						33	33	33																					33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8016	001	0	1	48	05	H8016_001_0	2	1	Generic Drugs	1	4	010000			111		01			1	30	60	90				2							30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	2.65	0.00	2.65			0.00	2.65			
H8016	001	0	1	48	05	H8016_001_0	2	2	Brand Drugs	1	4	000010			111		01			1	30	60	90				2							30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	6.60	0.00	6.60			0.00	6.60			
H8016	001	0	1	48	05	H8016_001_0	2	3	Non-Medicare Rx/OTC Drugs	1	4	010010			111		01			1	30	60	90				2							30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8026	001	0	1	48	05	H8026_001_0	11	3	Non-Medicare Rx/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/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8026	001	0	1	48	05	H8026_001_0	11	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/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8026	001	0	1	48	05	H8026_001_0	11	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/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8029	001	0	1	48	05	H8029_001_0	6	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				1			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			
H8029	001	0	1	48	05	H8029_001_0	6	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				1			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			
H8029	001	0	1	48	05	H8029_001_0	6	3	Non-Medicare Rx/OTC Drugs	1	4	010000			110		01	100		1	30		90				1			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			
H8046	001	0	1	48	05	H8046_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/OTC Drugs	1	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
H8046	001	0	1	48	05	H8046_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/OTC Drugs	1	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	5	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		01	010		1	31							31						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			
H8056	001	0	1	48	05	H8056_001_0	5	3	Non-Medicare Rx/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/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8056	001	0	1	48	05	H8056_001_0	5	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/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8056	001	0	1	48	05	H8056_001_0	5	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/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
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	.10	3.00	6.00	9.00																					.10	3.00	0.00	0.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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	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	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	0.00	0.00																		3.00				0.10	3.00		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												
H8091	002	0	1	04	01	H8091_002_0	11	5	Specialty Tier	1	4	010010	1	1		110	01	110		1				30		90	1	30		90				30		31													947.28	25		25					312.96	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	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		20.00					.10	3.00		6.00					.10	3.00		6.00																		10.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									1.00	30.00		60.00					.43	13.00		26.00					.43	13.00		26.00																		30.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	11	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					1.16	35.00		70.00					1.16	35.00		70.00																		40.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	11	4	Non-Preferred Brand	1	4	110000	1	1		110	01	110		1				30		90	1	30		90				30		31													26.09	33		33					18.19	30		30					30		30																	33				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	10	5	Specialty Tier	1	4	010010	1	1		110	01	110		1				30		90	1	30		90				30		31													853.58	25		25					338.14	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	10	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		20.00					.10	3.00		6.00					.10	3.00		6.00																		10.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	10	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									1.00	30.00		60.00					.43	13.00		26.00					.43	13.00		26.00																		30.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	10	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					1.16	35.00		70.00					1.16	35.00		70.00																		40.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	10	4	Non-Preferred Brand	1	4	110000	1	1		110	01	110		1				30		90	1	30		90				30		31													48.92	33		33					37.02	30		30					30		30																	33				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	11	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	11	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	11	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	11	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												
H8130	001	0	1	01	01	H8130_001_0	11	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												
H8133	001	0	1	01	01	H8133_001_0	15	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					0.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	001	0	1	01	01	H8133_001_0	15	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	15	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	15	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	15	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	15	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	001	0	1	01	01	H8133_001_0	15	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	003	0	1	09	04	H8145_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		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												
H8145	003	0	1	09	04	H8145_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		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												
H8145	003	0	1	09	04	H8145_003_0	4	5	Specialty Tier	3	4	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										2	3	
H8145	003	0	1	09	04	H8145_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		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										2	3	
H8145	003	0	1	09	04	H8145_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		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										2	3	
H8145	003	0	1	09	04	H8145_003_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	003	0	1	09	04	H8145_003_0	4	5	Specialty Tier	1	4	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												
H8145	003	0	1	09	04	H8145_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_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		54.00				0.60	18.00		0.00				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	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		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												
H8145	004	0	1	09	04	H8145_004_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		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												
H8145	004	0	1	09	04	H8145_004_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	004	0	1	09	04	H8145_004_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		54.00				0.60	18.00		0.00				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	3	5	Specialty Tier	1	4	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												
H8145	004	0	1	09	04	H8145_004_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		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										2	3	
H8145	004	0	1	09	04	H8145_004_0	3	5	Specialty Tier	3	4	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										2	3	
H8145	004	0	1	09	04	H8145_004_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				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	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		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										2	3	
H8145	005	0	1	09	04	H8145_005_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		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												
H8145	005	0	1	09	04	H8145_005_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		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												
H8145	005	0	1	09	04	H8145_005_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				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	3	5	Specialty Tier	3	4	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										2	3	
H8145	005	0	1	09	04	H8145_005_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		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										2	3	
H8145	005	0	1	09	04	H8145_005_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	005	0	1	09	04	H8145_005_0	3	5	Specialty Tier	1	4	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												
H8145	005	0	1	09	04	H8145_005_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		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										2	3	
H8145	005	0	1	09	04	H8145_005_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		45.00				0.50	15.00		0.00				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	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		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												
H8145	006	0	1	09	04	H8145_006_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		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												
H8145	006	0	1	09	04	H8145_006_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				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	3	5	Specialty Tier	3	4	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										2	3	
H8145	006	0	1	09	04	H8145_006_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		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										2	3	
H8145	006	0	1	09	04	H8145_006_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		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										2	3	
H8145	006	0	1	09	04	H8145_006_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	006	0	1	09	04	H8145_006_0	3	5	Specialty Tier	1	4	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												
H8145	008	0	1	09	04	H8145_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		18.00				0.20	6.00		0.00				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	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		45.00				0.50	15.00		0.00				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	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		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												
H8145	008	0	1	09	04	H8145_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		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										2	3	
H8145	008	0	1	09	04	H8145_008_0	3	5	Specialty Tier	3	4	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										2	3	
H8145	008	0	1	09	04	H8145_008_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	008	0	1	09	04	H8145_008_0	3	5	Specialty Tier	1	4	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												
H8145	008	0	1	09	04	H8145_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		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												
H8145	008	0	1	09	04	H8145_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		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										2	3	
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		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												
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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				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	5	Specialty Tier	3	4	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										2	3	
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		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												
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		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										2	3	
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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		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	1	4	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												
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		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										2	3	
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		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												
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	0.40	12.00		36.00																												0.40	12.00		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	0.13	4.00		12.00																												0.13	4.00		12.00				0.13	4.00		0.00				4.00				0.12	4.00		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	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		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										2	3	
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	0.40	12.00		36.00																												0.40	12.00		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	012	0	1	09	04	H8145_012_0	3	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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		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						25																														25							25					25				25	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		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												
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		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										2	3	
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						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	020	0	1	09	04	H8145_020_0	3	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		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												
H8145	020	0	1	09	04	H8145_020_0	3	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		33.00				0.36	11.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	020	0	1	09	04	H8145_020_0	3	5	Specialty Tier	3	4	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										2	3	
H8145	020	0	1	09	04	H8145_020_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		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										2	3	
H8145	020	0	1	09	04	H8145_020_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		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										2	3	
H8145	020	0	1	09	04	H8145_020_0	3	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		33.00				0.36	11.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	020	0	1	09	04	H8145_020_0	3	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		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										2	3	
H8145	020	0	1	09	04	H8145_020_0	3	5	Specialty Tier	1	4	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												
H8145	020	0	1	09	04	H8145_020_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		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												
H8145	020	0	1	09	04	H8145_020_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		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												
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	0.13	4.00		12.00																												0.13	4.00		12.00				0.13	4.00		0.00				4.00				0.12	4.00		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	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		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										2	3	
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		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										2	3	
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	0.36	11.00		33.00																												0.36	11.00		33.00				0.36	11.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	021	0	1	09	04	H8145_021_0	4	5	Specialty Tier	3	4	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										2	3	
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						25																														25							25					25				25	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		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												
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		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												
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	0.36	11.00		33.00																												0.36	11.00		33.00				0.36	11.00		0.00				11.00				0.35	11.00		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	0.13	4.00		12.00																												0.13	4.00		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	032	0	1	09	04	H8145_032_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		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												
H8145	032	0	1	09	04	H8145_032_0	3	5	Specialty Tier	1	4	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												
H8145	032	0	1	09	04	H8145_032_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	032	0	1	09	04	H8145_032_0	3	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		39.00				0.43	13.00		0.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	032	0	1	09	04	H8145_032_0	3	5	Specialty Tier	3	4	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										2	3	
H8145	032	0	1	09	04	H8145_032_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	3	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		39.00				0.43	13.00		0.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_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		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												
H8145	032	0	1	09	04	H8145_032_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		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										2	3	
H8145	032	0	1	09	04	H8145_032_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		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										2	3	
H8145	051	0	1	09	04	H8145_051_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		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												
H8145	051	0	1	09	04	H8145_051_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		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												
H8145	051	0	1	09	04	H8145_051_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	051	0	1	09	04	H8145_051_0	3	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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	051	0	1	09	04	H8145_051_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	052	0	1	09	04	H8145_052_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		54.00				0.60	18.00		0.00				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	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		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										2	3	
H8145	052	0	1	09	04	H8145_052_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		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										2	3	
H8145	052	0	1	09	04	H8145_052_0	3	5	Specialty Tier	1	4	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												
H8145	052	0	1	09	04	H8145_052_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		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												
H8145	052	0	1	09	04	H8145_052_0	3	5	Specialty Tier	3	4	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										2	3	
H8145	052	0	1	09	04	H8145_052_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				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	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		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												
H8145	053	0	1	09	04	H8145_053_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		18.00				0.20	6.00		0.00				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	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		54.00				0.60	18.00		0.00				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	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		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												
H8145	053	0	1	09	04	H8145_053_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		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												
H8145	053	0	1	09	04	H8145_053_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	053	0	1	09	04	H8145_053_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		54.00				0.60	18.00		0.00				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	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		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										2	3	
H8145	053	0	1	09	04	H8145_053_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		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										2	3	
H8145	053	0	1	09	04	H8145_053_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		18.00				0.20	6.00		0.00				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	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		45.00				0.50	15.00		0.00				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	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		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												
H8145	061	0	1	09	04	H8145_061_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		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												
H8145	061	0	1	09	04	H8145_061_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H8145	061	0	1	09	04	H8145_061_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		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										2	3	
H8145	061	0	1	09	04	H8145_061_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	061	0	1	09	04	H8145_061_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	063	0	1	09	04	H8145_063_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		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										2	3	
H8145	063	0	1	09	04	H8145_063_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		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										2	3	
H8145	063	0	1	09	04	H8145_063_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		42.00				0.46	14.00		0.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	063	0	1	09	04	H8145_063_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	063	0	1	09	04	H8145_063_0	5	5	Specialty Tier	1	4	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												
H8145	063	0	1	09	04	H8145_063_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		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												
H8145	063	0	1	09	04	H8145_063_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		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												
H8145	063	0	1	09	04	H8145_063_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		42.00				0.46	14.00		0.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	5	5	Specialty Tier	3	4	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										2	3	
H8145	069	0	1	09	04	H8145_069_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		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												
H8145	069	0	1	09	04	H8145_069_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_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		39.00				0.43	13.00		0.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	5	5	Specialty Tier	1	3	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												
H8145	069	0	1	09	04	H8145_069_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		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												
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	3.16	95.00		285.00																												3.16	95.00		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												
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						30																														30							30					30				30	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		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												
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	0.50	15.00		45.00																												0.50	15.00		45.00				0.50	15.00		0.00				15.00				0.48	15.00		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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	078	0	1	09	04	H8145_078_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		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										2	3	
H8145	078	0	1	09	04	H8145_078_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		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										2	3	
H8145	078	0	1	09	04	H8145_078_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
H8145	078	0	1	09	04	H8145_078_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		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												
H8145	078	0	1	09	04	H8145_078_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	078	0	1	09	04	H8145_078_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		36.00				0.40	12.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	078	0	1	09	04	H8145_078_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		21.00				0.23	7.00		0.00				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	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		36.00				0.40	12.00		0.00				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	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_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		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												
H8145	084	0	1	09	04	H8145_084_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		36.00				0.40	12.00		0.00				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	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		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												
H8145	084	0	1	09	04	H8145_084_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	084	0	1	09	04	H8145_084_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		36.00				0.40	12.00		0.00				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	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		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										2	3	
H8145	084	0	1	09	04	H8145_084_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		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										2	3	
H8145	084	0	1	09	04	H8145_084_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	087	0	1	09	04	H8145_087_0	4	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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_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		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												
H8145	087	0	1	09	04	H8145_087_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		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												
H8145	087	0	1	09	04	H8145_087_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	3	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	3	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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_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		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												
H8145	089	0	1	09	04	H8145_089_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		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												
H8145	089	0	1	09	04	H8145_089_0	3	5	Specialty Tier	1	3	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												
H8145	091	0	1	09	04	H8145_091_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		15.00				0.16	5.00		0.00				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	5	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_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		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												
H8145	091	0	1	09	04	H8145_091_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		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												
H8145	091	0	1	09	04	H8145_091_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	093	0	1	09	04	H8145_093_0	3	5	Specialty Tier	3	4	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										2	3	
H8145	093	0	1	09	04	H8145_093_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		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										2	3	
H8145	093	0	1	09	04	H8145_093_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	093	0	1	09	04	H8145_093_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	093	0	1	09	04	H8145_093_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		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										2	3	
H8145	093	0	1	09	04	H8145_093_0	3	5	Specialty Tier	1	4	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												
H8145	093	0	1	09	04	H8145_093_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		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												
H8145	093	0	1	09	04	H8145_093_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		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												
H8145	093	0	1	09	04	H8145_093_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	093	0	1	09	04	H8145_093_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		12.00				0.13	4.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	103	0	1	09	04	H8145_103_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	103	0	1	09	04	H8145_103_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		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										2	3	
H8145	103	0	1	09	04	H8145_103_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		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										2	3	
H8145	103	0	1	09	04	H8145_103_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_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		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												
H8145	103	0	1	09	04	H8145_103_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		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												
H8145	103	0	1	09	04	H8145_103_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	104	0	1	09	04	H8145_104_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		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										2	3	
H8145	104	0	1	09	04	H8145_104_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		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										2	3	
H8145	104	0	1	09	04	H8145_104_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	104	0	1	09	04	H8145_104_0	3	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		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										2	3	
H8145	104	0	1	09	04	H8145_104_0	3	5	Specialty Tier	1	4	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												
H8145	104	0	1	09	04	H8145_104_0	3	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		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												
H8145	104	0	1	09	04	H8145_104_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	104	0	1	09	04	H8145_104_0	3	5	Specialty Tier	3	4	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										2	3	
H8145	104	0	1	09	04	H8145_104_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		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												
H8145	104	0	1	09	04	H8145_104_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		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												
H8145	122	0	1	09	04	H8145_122_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		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												
H8145	122	0	1	09	04	H8145_122_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	122	0	1	09	04	H8145_122_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		36.00				0.40	12.00		0.00				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	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		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										2	3	
H8145	122	0	1	09	04	H8145_122_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		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										2	3	
H8145	122	0	1	09	04	H8145_122_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		21.00				0.23	7.00		0.00				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	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		36.00				0.40	12.00		0.00				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	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		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												
H8145	123	0	1	09	04	H8145_123_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		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												
H8145	123	0	1	09	04	H8145_123_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		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												
H8145	123	0	1	09	04	H8145_123_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		45.00				0.50	15.00		0.00				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	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		21.00				0.23	7.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	123	0	1	09	04	H8145_123_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		45.00				0.50	15.00		0.00				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	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		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										2	3	
H8145	123	0	1	09	04	H8145_123_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		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										2	3	
H8145	123	0	1	09	04	H8145_123_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_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		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												
H8145	125	0	1	09	04	H8145_125_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		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												
H8145	125	0	1	09	04	H8145_125_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		36.00				0.40	12.00		0.00				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	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		21.00				0.23	7.00		0.00				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	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H8145	125	0	1	09	04	H8145_125_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		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										2	3	
H8145	125	0	1	09	04	H8145_125_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		36.00				0.40	12.00		0.00				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	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	154	0	1	09	04	H8145_154_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	154	0	1	09	04	H8145_154_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		45.00				0.50	15.00		0.00				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	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		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												
H8145	154	0	1	09	04	H8145_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		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												
H8145	154	0	1	09	04	H8145_154_0	3	5	Specialty Tier	3	4	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										2	3	
H8145	154	0	1	09	04	H8145_154_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		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										2	3	
H8145	154	0	1	09	04	H8145_154_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		45.00				0.50	15.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	154	0	1	09	04	H8145_154_0	3	5	Specialty Tier	1	4	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												
H8145	154	0	1	09	04	H8145_154_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		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										2	3	
H8146	001	0	1	01	01	H8146_001_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	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	001	0	1	01	01	H8146_001_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	7.50																					.10	3.00	6.00	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	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	001	0	1	01	01	H8146_001_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	001	0	1	01	01	H8146_001_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	001	0	1	01	01	H8146_001_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	002	0	1	01	01	H8146_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	.40	12.00	24.00	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	002	0	1	01	01	H8146_002_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	002	0	1	01	01	H8146_002_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	002	0	1	01	01	H8146_002_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	002	0	1	01	01	H8146_002_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	002	0	1	01	01	H8146_002_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	003	0	1	01	01	H8146_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	.40	12.00	24.00	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	004	0	1	01	01	H8146_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	004	0	1	01	01	H8146_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	.40	12.00	24.00	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	004	0	1	01	01	H8146_004_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	004	0	1	01	01	H8146_004_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	004	0	1	01	01	H8146_004_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	004	0	1	01	01	H8146_004_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	005	0	1	01	01	H8146_005_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_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	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	006	0	1	01	01	H8146_006_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	006	0	1	01	01	H8146_006_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	006	0	1	01	01	H8146_006_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	006	0	1	01	01	H8146_006_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	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	006	0	1	01	01	H8146_006_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	006	0	1	01	01	H8146_006_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	007	0	1	01	01	H8146_007_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	007	0	1	01	01	H8146_007_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	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	007	0	1	01	01	H8146_007_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	007	0	1	01	01	H8146_007_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	007	0	1	01	01	H8146_007_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	007	0	1	01	01	H8146_007_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	008	0	1	01	01	H8146_008_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	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	009	0	1	01	01	H8146_009_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_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	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	010	0	1	01	01	H8146_010_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	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_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	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	011	0	1	01	01	H8146_011_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_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	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	012	0	1	01	01	H8146_012_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	013	0	1	01	01	H8146_013_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	013	0	1	01	01	H8146_013_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	013	0	1	01	01	H8146_013_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	013	0	1	01	01	H8146_013_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	013	0	1	01	01	H8146_013_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	013	0	1	01	01	H8146_013_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	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_0	7	4	Non-Preferred Brand	1	4	110000	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_0	7	5	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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_0	7	3	Preferred Brand	1	4	010001	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_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	30.00																					.40	12.00	24.00	30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	014	0	1	01	01	H8146_014_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	7.50																					.10	3.00	6.00	7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8150	001	0	1	48	05	H8150_001_0	8	1	Generic Drugs	1	4	010000			111		01	111		1	30	60	90				2	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8150	001	0	1	48	05	H8150_001_0	8	4	Non-Medicare OTC Drugs	1	4	010000			111		01	111		1	30	60	90				2	30	60	90				30		34																																																					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			
H8150	001	0	1	48	05	H8150_001_0	8	3	Non-Medicare Rx Drugs	1	4	010000			111		01	111		1	30	60	90				2	30	60	90				30		34																																																					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			
H8150	001	0	1	48	05	H8150_001_0	8	2	Brand Drugs	1	4	000010			111		01	111		1	30	60	90				2	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8170	001	0	1	01	01	H8170_001_0	8	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	.20	6.00		18.00																					.20	6.00		15.00																		6.00				.19	6.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8170	001	0	1	01	01	H8170_001_0	8	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												
H8170	001	0	1	01	01	H8170_001_0	8	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												
H8170	001	0	1	01	01	H8170_001_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												
H8170	002	0	1	01	01	H8170_002_0	7	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	.20	6.00		18.00																					.20	6.00		15.00																		6.00				.19	6.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8170	002	0	1	01	01	H8170_002_0	7	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												
H8170	002	0	1	01	01	H8170_002_0	7	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												
H8170	002	0	1	01	01	H8170_002_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												
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												
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												
H8213	001	0	1	48	05	H8213_001_0	8	3	Non-Medicare Rx/OTC Drugs	1	4	000010			110		01	100		1	30		90				1			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			
H8213	001	0	1	48	05	H8213_001_0	8	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				1			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			
H8213	001	0	1	48	05	H8213_001_0	8	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				1			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			
H8237	001	0	1	01	01	H8237_001_0	5	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												
H8237	001	0	1	01	01	H8237_001_0	5	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	5	3	Preferred Brand	1	4	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	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8258	001	0	1	48	05	H8258_001_0	5	3	Non-Medicare Rx Drugs	1	4	010010			111		01	111		1	30	60	90				1	30	60	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			
H8258	001	0	1	48	05	H8258_001_0	5	4	Non-Medicare 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 Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8258	001	0	1	48	05	H8258_001_0	5	2	Brand Drugs	1	4	000010			111		10	111		1	30	60	90				2	30	60	90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	6.60			0.00	6.60	0.00	6.60			
H8258	001	0	1	48	05	H8258_001_0	5	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 Drugs, Non-Medicare OTC Drugs	1	0.00	2.65	0.00	2.65	0.00	2.65	0.00	2.65			
H8266	001	0	1	01	01	H8266_001_0	5	1	Generic	1	4	010000	1	2	111		01	111		1	30	60	90				1	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	5	1	Generic	3	4	010000	1	2	111		01	111		1	30	60	90				1	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8266	001	0	1	01	01	H8266_001_0	5	4	Specialty Tier	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		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	5	2	Preferred Brand	1	4	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	135.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	5	3	Non-Preferred Brand	1	4	100000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.41	75.00	150.00	225.00																					2.41	75.00	150.00	225.00																		75.00				2.41	75.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	5	2	Preferred Brand	1	2	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.45	45.00	90.00	135.00																								90.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	5	1	Generic	1	2	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	.19	6.00	12.00	18.00																								12.00																		6.00				.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	5	4	Specialty Tier	1	2	100000	1	1	111		01	100		1	30	60	90				1			90				30		31					100.00	25	25	25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	5	3	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.06	95.00	190.00	285.00																								190.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8393	001	0	1	04	01	H8393_001_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.30	9.00	18.00	27.00					.13	4.00	8.00	12.00					.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	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.40	12.00	24.00	36.00					.30	9.00	18.00	27.00					.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	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8393	001	0	1	04	01	H8393_001_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													49.80	50	50	50					46.48	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8393	001	0	1	04	01	H8393_001_0	4	3	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	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												
H8417	001	0	1	48	05	H8417_001_0	5	1	Generic Drugs	1	4	010010			111		10	111		1	31	62	93				1	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8417	001	0	1	48	05	H8417_001_0	5	2	Brand Drugs	1	4	010010			111		10	111		1	31	62	93				1	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8417	001	0	1	48	05	H8417_001_0	5	3	Non-Medicare Rx Drugs	1	4	010000			010		10			1	31														10	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			
H8417	001	0	1	48	05	H8417_001_0	5	4	Non-Medicare OTC Drugs	1	4	010000			010		10			1	31														10	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			
H8420	001	0	1	48	05	H8420_001_0	6	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8420	001	0	1	48	05	H8420_001_0	6	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8432	002	0	1	01	01	H8432_002_0	10	6	Select Care Drugs	1	3	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												
H8432	002	0	1	01	01	H8432_002_0	10	5	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, Specialty Tier, Select Care Drugs												
H8432	002	0	1	01	01	H8432_002_0	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									3.16	95.00	190.00	285.00					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	002	0	1	01	01	H8432_002_0	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00					1.00	30.00	90.00	90.00																		30.00				.88	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	002	0	1	01	01	H8432_002_0	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.16	5.00	10.00	15.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	002	0	1	01	01	H8432_002_0	10	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.33	10.00	20.00	30.00					.33	10.00	20.00	30.00					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	12	5	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, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	12	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.10	33.00	66.00	99.00					.93	28.00	56.00	84.00					.93	28.00	56.00	56.00																		33.00				.97	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	12	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	12	6	Select Care Drugs	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												
H8452	001	0	1	48	05	H8452_001_0	6	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx 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	6	4	Non-Medicare OTC Drugs	1	4	010010			110		01	100		1	30		90				2			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			
H8452	001	0	1	48	05	H8452_001_0	6	3	Non-Medicare Rx Drugs	1	4	010010			110		01	100		1	30		90				2			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			
H8452	001	0	1	48	05	H8452_001_0	6	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8490	001	0	1	48	05	H8490_001_0	5	3	Non-Medicare Rx Drugs	1	4	010010			110		01	100		1	30		90				1			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			
H8490	001	0	1	48	05	H8490_001_0	5	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				1			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8490	001	0	1	48	05	H8490_001_0	5	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				1			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8490	001	0	1	48	05	H8490_001_0	5	4	Non-Medicare OTC Drugs	1	4	010010			110		01	100		1	30		90				1			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			
H8506	001	0	1	01	01	H8506_001_0	6	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												
H8506	001	0	1	01	01	H8506_001_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	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8506	001	0	1	01	01	H8506_001_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	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8506	001	0	1	01	01	H8506_001_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	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8506	001	0	1	01	01	H8506_001_0	6	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												
H8552	020	0	1	04	01	H8552_020_0	15	5	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, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	15	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	15	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	15	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.90	27.00	54.00	81.00					.73	22.00	44.00	66.00					.73	22.00	44.00	44.00																		27.00				.79	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	15	6	Select Care Drugs	1	3	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												
H8552	020	0	1	04	01	H8552_020_0	15	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	021	0	1	04	01	H8552_021_0	14	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	021	0	1	04	01	H8552_021_0	14	6	Select Care Drugs	1	3	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												
H8552	021	0	1	04	01	H8552_021_0	14	5	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, Specialty Tier, Select Care Drugs												
H8552	021	0	1	04	01	H8552_021_0	14	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	021	0	1	04	01	H8552_021_0	14	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	021	0	1	04	01	H8552_021_0	14	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.70	21.00	42.00	63.00					.53	16.00	32.00	48.00					.53	16.00	32.00	32.00																		21.00				0.61	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	022	0	1	04	01	H8552_022_0	15	5	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, Specialty Tier, Select Care Drugs												
H8552	022	0	1	04	01	H8552_022_0	15	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	022	0	1	04	01	H8552_022_0	15	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	022	0	1	04	01	H8552_022_0	15	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.73	22.00	44.00	66.00					.56	17.00	34.00	51.00					0.56	17.00	34.00	34.00																		22.00				0.64	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	022	0	1	04	01	H8552_022_0	15	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	022	0	1	04	01	H8552_022_0	15	6	Select Care Drugs	1	3	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												
H8552	024	0	1	04	01	H8552_024_0	16	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	024	0	1	04	01	H8552_024_0	16	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.70	21.00	42.00	63.00					.53	16.00	32.00	48.00					0.53	16.00	32.00	32.00																		21.00				0.61	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	024	0	1	04	01	H8552_024_0	16	6	Select Care Drugs	1	3	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												
H8552	024	0	1	04	01	H8552_024_0	16	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														31								31							31																			31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	024	0	1	04	01	H8552_024_0	16	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.66	80.00	160.00	240.00					2.50	75.00	150.00	225.00					2.50	75.00	225.00	225.00																		80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	024	0	1	04	01	H8552_024_0	16	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					1.06	32.00	64.00	96.00					1.06	32.00	96.00	96.00																		37.00				1.08	37.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	027	0	1	04	01	H8552_027_0	15	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	027	0	1	04	01	H8552_027_0	15	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	027	0	1	04	01	H8552_027_0	15	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.90	27.00	54.00	81.00					.73	22.00	44.00	66.00					0.73	22.00	44.00	44.00																		27.00				0.79	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	027	0	1	04	01	H8552_027_0	15	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	027	0	1	04	01	H8552_027_0	15	5	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, Specialty Tier, Select Care Drugs												
H8552	027	0	1	04	01	H8552_027_0	15	6	Select Care Drugs	1	3	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												
H8554	001	0	1	01	01	H8554_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	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	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												
H8554	001	0	1	01	01	H8554_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	0.33	10.00	20.00	30.00																					.33	10.00	20.00	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	9	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																					.13	4.00	8.00	8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	9	5	Specialty Tier	1	4	100101	1	1	111		01	010		1	30	60	90				1	30						30		31						33	33	33																					33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	5	1	Generic	1	4	010000	1	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												
H8578	001	0	1	01	01	H8578_001_0	5	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	001	0	1	01	01	H8578_001_0	5	3	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																								270.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	5	4	Specialty Tier	1	4	100001	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	5	1	Generic	3	4	010000	1	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	004	0	1	01	01	H8578_004_0	5	4	Specialty Tier	1	4	100001	3	1	010		01			1	30													30		31					1.00	33																																										33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	5	3	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																								270.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	5	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	004	0	1	01	01	H8578_004_0	5	1	Generic	1	4	010000	1	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												
H8578	004	0	1	01	01	H8578_004_0	5	1	Generic	3	4	010000	1	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	5	3	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																								270.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	007	0	1	01	01	H8578_007_0	5	4	Specialty Tier	1	4	100001	3	1	010		01			1	30													30		31					1.00	33																																										33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	007	0	1	01	01	H8578_007_0	5	1	Generic	3	4	010000	1	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	5	1	Generic	1	4	010000	1	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												
H8578	007	0	1	01	01	H8578_007_0	5	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	010	0	1	02	01	H8578_010_0	6	1	Generic	1	4	010000	1	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												
H8578	010	0	1	02	01	H8578_010_0	6	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	010	0	1	02	01	H8578_010_0	6	3	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																								270.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	010	0	1	02	01	H8578_010_0	6	4	Specialty Tier	1	4	100001	3	1	010		01			1	30													30		31					1.00	33																																										33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	010	0	1	02	01	H8578_010_0	6	1	Generic	3	4	010000	1	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	012	0	1	01	01	H8578_012_0	5	1	Generic	1	4	010000	1	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												
H8578	012	0	1	01	01	H8578_012_0	5	2	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	.40	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	5	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	1.45	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	5	4	Specialty Tier	1	4	100000	3	1	010		01			1	30													30		31					1.00	29																																										29				29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	013	0	1	01	01	H8578_013_0	4	1	Generic	1	4	010000	1	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												
H8578	013	0	1	01	01	H8578_013_0	4	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	013	0	1	01	01	H8578_013_0	4	4	Specialty Tier	1	4	100001	3	1	010		01			1	30													30		31					1.00	33																																										33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	013	0	1	01	01	H8578_013_0	4	3	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																								270.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	014	0	1	01	01	H8578_014_0	4	1	Generic	1	4	010000	1	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												
H8578	014	0	1	01	01	H8578_014_0	4	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	014	0	1	01	01	H8578_014_0	4	3	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																								270.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	014	0	1	01	01	H8578_014_0	4	4	Specialty Tier	1	4	100001	3	1	010		01			1	30													30		31					1.00	33																																										33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	014	0	1	01	01	H8578_014_0	4	1	Generic	3	4	010000	1	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	015	0	1	02	01	H8578_015_0	6	1	Generic	1	4	010000	1	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												
H8578	015	0	1	02	01	H8578_015_0	6	3	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																								270.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	015	0	1	02	01	H8578_015_0	6	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	015	0	1	02	01	H8578_015_0	6	4	Specialty Tier	1	4	100001	3	1	010		01			1	30													30		31					1.00	33																																										33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	007	1	1	04	01	H8604_007_1	5	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	007	1	1	04	01	H8604_007_1	5	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	007	1	1	04	01	H8604_007_1	5	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	007	1	1	04	01	H8604_007_1	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																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	007	1	1	04	01	H8604_007_1	5	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	007	2	1	04	01	H8604_007_2	5	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	007	2	1	04	01	H8604_007_2	5	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	007	2	1	04	01	H8604_007_2	5	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	007	2	1	04	01	H8604_007_2	5	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	007	2	1	04	01	H8604_007_2	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																								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	10	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	10	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	001	0	1	04	01	H8634_001_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	001	0	1	04	01	H8634_001_0	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	10	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	002	0	1	04	01	H8634_002_0	12	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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													1330.00	33		33					1330.00	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									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		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									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	14	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	14	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	14	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	14	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	14	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					0.00	0.00		0.00								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	15	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	15	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					0.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	004	0	1	04	01	H8634_004_0	15	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	004	0	1	04	01	H8634_004_0	15	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	15	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	15	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	15	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	005	0	1	04	01	H8634_005_0	13	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	005	0	1	04	01	H8634_005_0	13	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	005	0	1	04	01	H8634_005_0	13	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	005	0	1	04	01	H8634_005_0	13	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	005	0	1	04	01	H8634_005_0	13	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	005	0	1	04	01	H8634_005_0	13	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	005	0	1	04	01	H8634_005_0	13	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.00	0.00		0.00								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	003	0	1	01	01	H8649_003_0	9	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	20.00					0.16	5.00	10.00	10.00					0.16	5.00	10.00	10.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	003	0	1	01	01	H8649_003_0	9	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	003	0	1	01	01	H8649_003_0	9	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													42.89	50	50	50					40.51	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	003	0	1	01	01	H8649_003_0	9	3	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	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												
H8649	003	0	1	01	01	H8649_003_0	9	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.10	33.00	66.00	99.00					0.93	28.00	56.00	84.00					0.93	28.00	56.00	84.00																			33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8677	001	0	1	48	05	H8677_001_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		01	010		1	31							31						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			
H8677	001	0	1	48	05	H8677_001_0	4	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/OTC Drugs	1	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	4	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/OTC Drugs	1	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
H8677	002	0	1	48	05	H8677_002_0	4	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/OTC Drugs	1	0.00	6.60	0.00	6.60	0.00	6.60	0.00	6.60			
H8677	002	0	1	48	05	H8677_002_0	4	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/OTC Drugs	1	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	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		01	010		1	31							31						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			
H8748	002	0	1	01	01	H8748_002_0	2	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							275.00				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	2	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							125.00				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	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8748	002	0	1	01	01	H8748_002_0	2	5	Specialty Tier	1	3	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												
H8764	001	0	1	01	01	H8764_001_0	6	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																								150.00																		75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	6	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	6	2	Non-Preferred Generic	1	4	000100	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, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.07	2.00		6.00																								4.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31						29		29																							29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_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												
H8764	002	0	1	02	01	H8764_002_0	6	2	Non-Preferred Generic	1	4	000100	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, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	6	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	6	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																								150.00																		75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	6	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												
H8764	003	0	1	01	01	H8764_003_0	6	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												
H8764	003	0	1	01	01	H8764_003_0	6	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			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												
H8764	003	0	1	01	01	H8764_003_0	6	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												
H8764	003	0	1	01	01	H8764_003_0	6	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.67	80.00		240.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	6	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				1			90				30		31						26		26																							26																	26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8822	004	0	1	01	01	H8822_004_0	12	1	Generic	1	4	010000	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8822	004	0	1	01	01	H8822_004_0	12	2	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8822	004	0	1	01	01	H8822_004_0	12	3	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		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8822	004	0	1	01	01	H8822_004_0	12	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8822	004	0	1	01	01	H8822_004_0	12	5	Select Care Drugs	1	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	.08	2.50		7.50																					.08	2.50		5.00																		2.50				.07	2.50		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8822	004	0	1	01	01	H8822_004_0	12	1	Generic	3	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H8822	004	0	1	01	01	H8822_004_0	12	5	Select Care Drugs	3	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	.08	2.50		7.50																					.08	2.50		5.00																		2.50				.08	2.50		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H8851	001	0	1	48	05	H8851_001_0	7	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 Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8851	001	0	1	48	05	H8851_001_0	7	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 Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8851	001	0	1	48	05	H8851_001_0	7	3	Non-Medicare Rx Drugs	1	4	010010			111		01	111		1	30	60	90				2	30	60	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			
H8851	001	0	1	48	05	H8851_001_0	7	4	Non-Medicare OTC Drugs	1	4	010010			111		01	111		1	30	60	90				2	30	60	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			
H8908	001	0	1	01	01	H8908_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		18.00				0.20	6.00		0.00				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	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		45.00				0.50	15.00		0.00				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	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		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												
H8908	001	0	1	01	01	H8908_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		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												
H8908	001	0	1	01	01	H8908_001_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8908	001	0	1	01	01	H8908_001_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		45.00				0.50	15.00		0.00				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	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		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										2	3	
H8908	001	0	1	01	01	H8908_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		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										2	3	
H8908	001	0	1	01	01	H8908_001_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		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										2	3	
H8953	001	0	1	01	01	H8953_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		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										2	3	
H8953	001	0	1	01	01	H8953_001_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						26																														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	001	0	1	01	01	H8953_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		15.00				0.16	5.00		0.00				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	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		45.00				0.50	15.00		0.00				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	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		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												
H8953	001	0	1	01	01	H8953_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		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												
H8953	001	0	1	01	01	H8953_001_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						26																														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	001	0	1	01	01	H8953_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	001	0	1	01	01	H8953_001_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		45.00				0.50	15.00		0.00				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	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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	002	0	1	01	01	H8953_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		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										2	3	
H8953	002	0	1	01	01	H8953_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		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												
H8953	002	0	1	01	01	H8953_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		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												
H8953	002	0	1	01	01	H8953_002_0	3	5	Specialty Tier	1	4	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												
H8953	002	0	1	01	01	H8953_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	002	0	1	01	01	H8953_002_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		45.00				0.50	15.00		0.00				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	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		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										2	3	
H8953	002	0	1	01	01	H8953_002_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		45.00				0.50	15.00		0.00				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	3	5	Specialty Tier	3	4	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										2	3	
H8953	003	0	1	01	01	H8953_003_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		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										2	3	
H8953	003	0	1	01	01	H8953_003_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		54.00				0.60	18.00		0.00				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	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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	003	0	1	01	01	H8953_003_0	3	5	Specialty Tier	1	4	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												
H8953	003	0	1	01	01	H8953_003_0	3	5	Specialty Tier	3	4	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										2	3	
H8953	003	0	1	01	01	H8953_003_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		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												
H8953	003	0	1	01	01	H8953_003_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		54.00				0.60	18.00		0.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	003	0	1	01	01	H8953_003_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		18.00				0.20	6.00		0.00				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	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		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										2	3	
H8953	003	0	1	01	01	H8953_003_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		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												
H8953	005	0	1	01	01	H8953_005_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						26																														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	005	0	1	01	01	H8953_005_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		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										2	3	
H8953	005	0	1	01	01	H8953_005_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		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										2	3	
H8953	005	0	1	01	01	H8953_005_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	005	0	1	01	01	H8953_005_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	005	0	1	01	01	H8953_005_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						26																														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	005	0	1	01	01	H8953_005_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		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												
H8953	005	0	1	01	01	H8953_005_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		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												
H8953	005	0	1	01	01	H8953_005_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	005	0	1	01	01	H8953_005_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	006	0	1	01	01	H8953_006_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		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												
H8953	006	0	1	01	01	H8953_006_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		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												
H8953	006	0	1	01	01	H8953_006_0	3	5	Specialty Tier	1	4	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												
H8953	006	0	1	01	01	H8953_006_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	006	0	1	01	01	H8953_006_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	006	0	1	01	01	H8953_006_0	3	5	Specialty Tier	3	4	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										2	3	
H8953	006	0	1	01	01	H8953_006_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		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										2	3	
H8953	006	0	1	01	01	H8953_006_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		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										2	3	
H8953	006	0	1	01	01	H8953_006_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	006	0	1	01	01	H8953_006_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	007	0	1	01	01	H8953_007_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												
H8953	007	0	1	01	01	H8953_007_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	007	0	1	01	01	H8953_007_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		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												
H8953	007	0	1	01	01	H8953_007_0	4	5	Specialty Tier	1	3	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												
H8953	007	0	1	01	01	H8953_007_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		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												
H8953	009	0	1	01	01	H8953_009_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		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										2	3	
H8953	009	0	1	01	01	H8953_009_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	009	0	1	01	01	H8953_009_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	009	0	1	01	01	H8953_009_0	3	5	Specialty Tier	1	4	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												
H8953	009	0	1	01	01	H8953_009_0	3	5	Specialty Tier	3	4	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										2	3	
H8953	009	0	1	01	01	H8953_009_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		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												
H8953	009	0	1	01	01	H8953_009_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	009	0	1	01	01	H8953_009_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	009	0	1	01	01	H8953_009_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		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										2	3	
H8953	009	0	1	01	01	H8953_009_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		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												
H8953	010	0	1	01	01	H8953_010_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		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										2	3	
H8953	010	0	1	01	01	H8953_010_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		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										2	3	
H8953	010	0	1	01	01	H8953_010_0	3	5	Specialty Tier	3	4	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										2	3	
H8953	010	0	1	01	01	H8953_010_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		18.00				0.20	6.00		0.00				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	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	010	0	1	01	01	H8953_010_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		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												
H8953	010	0	1	01	01	H8953_010_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		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												
H8953	010	0	1	01	01	H8953_010_0	3	5	Specialty Tier	1	4	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												
H8953	010	0	1	01	01	H8953_010_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	010	0	1	01	01	H8953_010_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	011	0	1	01	01	H8953_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H8953	011	0	1	01	01	H8953_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		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 Care Drugs										2	3	
H8953	011	0	1	01	01	H8953_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		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, Select Care Drugs										2	3	
H8953	011	0	1	01	01	H8953_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		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, Select Care Drugs												
H8953	011	0	1	01	01	H8953_011_0	3	5	Specialty Tier	1	4	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, Select Care Drugs												
H8953	011	0	1	01	01	H8953_011_0	3	5	Specialty Tier	3	4	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, Select Care Drugs										2	3	
H8953	011	0	1	01	01	H8953_011_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H8953	011	0	1	01	01	H8953_011_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8953	011	0	1	01	01	H8953_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		45.00				0.50	15.00		0.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8953	011	0	1	01	01	H8953_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		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 Care Drugs												
H8953	011	0	1	01	01	H8953_011_0	3	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8953	012	0	1	01	01	H8953_012_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8953	012	0	1	01	01	H8953_012_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8953	012	0	1	01	01	H8953_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		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 Care Drugs												
H8953	012	0	1	01	01	H8953_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		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, Select Care Drugs												
H8953	012	0	1	01	01	H8953_012_0	3	5	Specialty Tier	1	4	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, Select Care Drugs												
H8953	012	0	1	01	01	H8953_012_0	3	5	Specialty Tier	3	4	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, Select Care Drugs										2	3	
H8953	012	0	1	01	01	H8953_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		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, Select Care Drugs										2	3	
H8953	012	0	1	01	01	H8953_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		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 Care Drugs										2	3	
H8953	012	0	1	01	01	H8953_012_0	3	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		48.00				0.53	16.00		0.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H8953	012	0	1	01	01	H8953_012_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H8953	012	0	1	01	01	H8953_012_0	3	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8953	014	0	1	01	01	H8953_014_0	4	5	Specialty Tier	1	3	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												
H8953	014	0	1	01	01	H8953_014_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												
H8953	014	0	1	01	01	H8953_014_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		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												
H8953	014	0	1	01	01	H8953_014_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		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												
H8953	014	0	1	01	01	H8953_014_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		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												
H8980	002	0	1	04	01	H8980_002_0	6	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8980	002	0	1	04	01	H8980_002_0	6	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	002	0	1	04	01	H8980_002_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													51.49	50	50	50					50.65	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	002	0	1	04	01	H8980_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.50	15.00	30.00	45.00					0.33	10.00	20.00	30.00					0.33	10.00	20.00	30.00																			15.00			0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	002	0	1	04	01	H8980_002_0	6	3	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	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												
H8980	002	0	1	04	01	H8980_002_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00					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												
H8980	004	0	1	04	01	H8980_004_0	4	3	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	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												
H8980	004	0	1	04	01	H8980_004_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.50	15.00	30.00	45.00					0.33	10.00	20.00	30.00					0.33	10.00	20.00	30.00																			15.00			0.48	15.00		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	10	111		1				30	60	90	1	30	60	90					10	31									0.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00					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												
H8980	004	0	1	04	01	H8980_004_0	4	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8980	004	0	1	04	01	H8980_004_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													58.94	50	50	50					60.44	50	50	50					50	50	50																		50			50	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	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	005	0	1	04	01	H8980_005_0	5	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	005	0	1	04	01	H8980_005_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													57.17	50	50	50					55.82	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	005	0	1	04	01	H8980_005_0	5	3	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	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												
H8980	005	0	1	04	01	H8980_005_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.26	8.00	16.00	24.00					0.26	8.00	16.00	24.00																			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	5	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.73	22.00	44.00	66.00					0.40	12.00	24.00	36.00					0.40	12.00	24.00	36.00																			22.00			0.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	006	0	1	04	01	H8980_006_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	006	0	1	04	01	H8980_006_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													56.59	50	50	50					55.44	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	006	0	1	04	01	H8980_006_0	4	3	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	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												
H8980	006	0	1	04	01	H8980_006_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.73	22.00	44.00	66.00					0.40	12.00	24.00	36.00					0.40	12.00	24.00	36.00																			22.00			0.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	006	0	1	04	01	H8980_006_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.33	10.00	20.00	30.00					0.26	8.00	16.00	24.00					0.26	8.00	16.00	24.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	017	0	1	01	01	H8991_017_0	10	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												
H8991	017	0	1	01	01	H8991_017_0	10	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	30.00					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8991	017	0	1	01	01	H8991_017_0	10	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		40.00				1.17	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8991	017	0	1	01	01	H8991_017_0	10	4	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					2.33	70.00	140.00	210.00					2.33	70.00	210.00	210.00																		75.00				2.20	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8991	017	0	1	01	01	H8991_017_0	10	6	Select Care Drugs	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		
H8991	017	0	1	01	01	H8991_017_0	10	6	Select Care Drugs	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												
H8991	017	0	1	01	01	H8991_017_0	10	5	Specialty Tier	1	4	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, Specialty Tier, Select Care Drugs												
H8991	017	0	1	01	01	H8991_017_0	10	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		
H8991	028	0	1	01	01	H8991_028_0	11	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8991	028	0	1	01	01	H8991_028_0	11	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					.50	15.00	30.00	45.00					.50	15.00	30.00	30.00																		20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8991	028	0	1	01	01	H8991_028_0	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8991	028	0	1	01	01	H8991_028_0	11	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8991	028	0	1	01	01	H8991_028_0	11	5	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, Specialty Tier, Select Care Drugs												
H8991	028	0	1	01	01	H8991_028_0	11	6	Select Care Drugs	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												
H9001	013	0	1	02	01	H9001_013_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					.17	5.00	10.00	15.00					0.17	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	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.03	32.00	64.00	96.00					.90	27.00	54.00	81.00					0.90	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	8	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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	8	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					.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	8	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													1104.00	33	33	33					1104.00	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	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					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		1.00				.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_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					.17	5.00	10.00	15.00					.17	5.00	10.00	15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	7	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													800.00	33	33	33					800.00	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	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.03	32.00	64.00	96.00					.90	27.00	54.00	81.00					.90	27.00	54.00	81.00																		27.00				.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	019	0	1	01	01	H9001_019_0	7	1	Preferred Generic	1	3	001000	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	7	2	Preferred Brand	1	3	000001	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	7	3	Non-Preferred Brand	1	3	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	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.03	32.00	64.00	96.00					.90	27.00	54.00	81.00					.90	27.00	54.00	81.00																		27.00				.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_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					.17	5.00	10.00	15.00					.17	5.00	10.00	15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	8	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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	8	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					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		1.00				.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	8	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													690.00	33	33	33					690.00	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	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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	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					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		1.00				.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_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					.17	5.00	10.00	15.00					.17	5.00	10.00	15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.03	32.00	64.00	96.00					.90	27.00	54.00	81.00					.90	27.00	54.00	81.00																		27.00				.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	7	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													690.00	33	33	33					690.00	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	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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	7	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													690.00	33	33	33					690.00	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	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					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		1.00				.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	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					.17	5.00	10.00	15.00					.17	5.00	10.00	15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.03	32.00	64.00	96.00					.90	27.00	54.00	81.00					.90	27.00	54.00	81.00																		27.00				.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.03	32.00	64.00	96.00					.90	27.00	54.00	81.00					.90	27.00	54.00	81.00																		27.00				.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	7	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													690.00	33	33	33					690.00	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	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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	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					.17	5.00	10.00	15.00					.17	5.00	10.00	15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	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					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		1.00				.03	1.00		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													522.00	33	33	33					522.00	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	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					.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	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									.33	10.00	20.00	30.00					.17	5.00	10.00	15.00					0.17	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									1.03	32.00	64.00	96.00					.90	27.00	54.00	81.00					0.90	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	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													522.00	33	33	33					522.00	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	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					.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	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					.17	5.00	10.00	15.00					0.17	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	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.03	32.00	64.00	96.00					.90	27.00	54.00	81.00					0.90	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	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.03	32.00	64.00	96.00					.90	27.00	54.00	81.00					0.90	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	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					.17	5.00	10.00	15.00					0.17	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									.20	6.00	12.00	18.00					.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	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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													522.00	33	33	33					522.00	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	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					.17	5.00	10.00	15.00					0.17	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	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					.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	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									1.03	32.00	64.00	96.00					.90	27.00	54.00	81.00					0.90	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	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													522.00	33	33	33					522.00	33	33	33					33	33	33																	33				33	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									.33	10.00	20.00	30.00					.17	5.00	10.00	15.00					0.17	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	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					.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	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					1.03	32.00	64.00	96.00					1.03	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	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													812.00	25	25	25					812.00	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	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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									.20	6.00	12.00	18.00					.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	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									.33	10.00	20.00	30.00					.17	5.00	10.00	15.00					0.17	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	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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	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					1.03	32.00	64.00	96.00					1.03	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													812.00	25	25	25					812.00	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	7	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					1.03	32.00	64.00	96.00					1.03	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	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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	7	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													812.00	25	25	25					812.00	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	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					.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	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					.17	5.00	10.00	15.00					0.17	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	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					.17	5.00	10.00	15.00					0.17	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	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					.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	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					1.03	32.00	64.00	96.00					1.03	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									2.70	81.00	162.00	243.00					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													812.00	25	25	25					812.00	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	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					.17	5.00	10.00	15.00					0.17	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	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									.20	6.00	12.00	18.00					.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	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					1.03	32.00	64.00	96.00					1.03	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	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													812.00	25	25	25					812.00	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									2.70	81.00	162.00	243.00					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	033	0	1	02	01	H9001_033_0	9	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					.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	033	0	1	02	01	H9001_033_0	9	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					.17	5.00	10.00	15.00					0.17	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	033	0	1	02	01	H9001_033_0	9	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.70	81.00	162.00	243.00					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	033	0	1	02	01	H9001_033_0	9	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.03	32.00	64.00	96.00					.90	27.00	54.00	81.00					0.90	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	033	0	1	02	01	H9001_033_0	9	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													522.00	33	33	33					522.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9003	001	0	1	01	01	H9003_001_0	9	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	9	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	9	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	9	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	9	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	9	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	9	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				.15	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	9	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		
H9003	001	0	1	01	01	H9003_001_0	9	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					1131.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	9	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	9	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					1498.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	9	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	9	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				.15	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	9	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		
H9003	006	0	1	01	01	H9003_006_0	9	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	9	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	9	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	9	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												
H9047	001	0	1	01	01	H9047_001_0	10	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.66	20.00	40.00	60.00					.40	12.00	24.00	36.00												.66	20.00	40.00	60.00				.40	12.00	24.00	36.00				20.00				.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	3	Preferred Brand	1	3	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	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.33	10.00	20.00	30.00					.13	4.00	8.00	12.00												.33	10.00	20.00	30.00				.13	4.00	8.00	12.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	10	4	Non-Preferred Brand	1	3	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	5	Injectable Drugs	1	3	010010	1	1		010	01		010	1				30							30			30		34													66.35	33							66.35	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	6	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		34													1235.26	33							1235.26	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	11	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													1235.26	33							1235.26	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	11	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34													66.35	33							66.35	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	11	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	11	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					.40	12.00	24.00	36.00												.66	20.00	40.00	60.00				.40	12.00	24.00	36.00				20.00				.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	11	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.33	10.00	20.00	30.00					.13	4.00	8.00	12.00												.33	10.00	20.00	30.00				.13	4.00	8.00	12.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	11	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	13	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					.40	12.00	24.00	36.00												.66	20.00	40.00	60.00				.40	12.00	24.00	36.00				20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_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												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	13	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	13	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34													66.35	33							66.35	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	13	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													1235.26	33							1235.26	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	13	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.33	10.00	20.00	30.00					.13	4.00	8.00	12.00												.33	10.00	20.00	30.00				.13	4.00	8.00	12.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	9	6	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		34													1122.96	30							1122.96	30														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	9	5	Injectable Drugs	1	3	010010	1	1		010	01		010	1				30							30			30		34													60.48	30							60.48	30														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	9	4	Non-Preferred Brand	1	3	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	037	0	1	02	01	H9047_037_0	9	3	Preferred Brand	1	3	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	037	0	1	02	01	H9047_037_0	9	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.66	20.00	40.00	60.00					.40	12.00	24.00	36.00												.66	20.00	40.00	60.00				.40	12.00	24.00	36.00				20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	9	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.33	10.00	20.00	30.00					.13	4.00	8.00	12.00												.33	10.00	20.00	30.00				.13	4.00	8.00	12.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	9	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													1235.26	33							1235.26	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	9	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34													66.35	33							66.35	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	9	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	038	0	1	02	01	H9047_038_0	9	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	038	0	1	02	01	H9047_038_0	9	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					.40	12.00	24.00	36.00												.66	20.00	40.00	60.00				.40	12.00	24.00	36.00				20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	9	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.33	10.00	20.00	30.00					.13	4.00	8.00	12.00												.33	10.00	20.00	30.00				.13	4.00	8.00	12.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	10	6	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		34													1235.26	33							1235.26	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	10	5	Injectable Drugs	1	3	010010	1	1		010	01		010	1				30							30			30		34													66.35	33							66.35	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	10	4	Non-Preferred Brand	1	3	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	039	0	1	02	01	H9047_039_0	10	3	Preferred Brand	1	3	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	039	0	1	02	01	H9047_039_0	10	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.66	20.00	40.00	60.00					.50	15.00	30.00	45.00												.66	20.00	40.00	60.00				.50	15.00	30.00	45.00				20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	10	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.33	10.00	20.00	30.00					.26	8.00	16.00	24.00												.33	10.00	20.00	30.00				.26	8.00	16.00	24.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9104	006	0	1	01	01	H9104_006_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																					0.09	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	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												
H9104	006	0	1	01	01	H9104_006_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	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	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		
H9104	006	0	1	01	01	H9104_006_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					482.72	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	7	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	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		
H9104	006	0	1	01	01	H9104_006_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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9110	002	0	1	01	01	H9110_002_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.23	7.00		14.00																					0.23	7.00		14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9110	002	0	1	01	01	H9110_002_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9110	002	0	1	01	01	H9110_002_0	9	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												
H9110	002	0	1	01	01	H9110_002_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9110	002	0	1	01	01	H9110_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.40	12.00		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9115	001	0	1	48	05	H9115_001_0	6	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		10	110		1	30		90				2	30		90					10	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			
H9115	001	0	1	48	05	H9115_001_0	6	2	Brand Drugs	1	4	000010			110		10	110		1	30		90				2	30		90					10	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			
H9115	001	0	1	48	05	H9115_001_0	6	1	Generic Drugs	1	4	010000			110		10	110		1	30		90				2	30		90					10	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			
H9122	001	0	1	01	01	H9122_001_0	8	1	Preferred Generic	1	4	001000	1	2	110		01			1	30		90				1							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												
H9122	001	0	1	01	01	H9122_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01			1	30		90				1							30		31	0.50	15.00		45.00																																										15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9122	001	0	1	01	01	H9122_001_0	8	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	8	4	Non-Preferred Brand	1	4	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												
H9122	001	0	1	01	01	H9122_001_0	8	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												
H9190	003	0	1	01	01	H9190_003_0	6	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	6	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	003	0	1	01	01	H9190_003_0	6	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	6	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, Select Care Drugs												
H9190	003	0	1	01	01	H9190_003_0	6	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	6	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	6	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	6	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	6	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	6	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	6	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, Select Care Drugs												
H9190	004	0	1	01	01	H9190_004_0	6	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	7	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												
H9190	005	0	1	01	01	H9190_005_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												
H9190	005	0	1	01	01	H9190_005_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.66	20.00	40.00	60.00																								40.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	005	0	1	01	01	H9190_005_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												
H9190	005	0	1	01	01	H9190_005_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												
H9190	006	0	1	01	01	H9190_006_0	6	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	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.66	20.00	40.00	60.00																								40.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	006	0	1	01	01	H9190_006_0	6	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	006	0	1	01	01	H9190_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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	006	0	1	01	01	H9190_006_0	6	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	009	0	1	01	01	H9190_009_0	6	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	009	0	1	01	01	H9190_009_0	6	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	009	0	1	01	01	H9190_009_0	6	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	009	0	1	01	01	H9190_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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	009	0	1	01	01	H9190_009_0	6	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	009	0	1	01	01	H9190_009_0	6	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	010	0	1	01	01	H9190_010_0	6	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	010	0	1	01	01	H9190_010_0	6	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	010	0	1	01	01	H9190_010_0	6	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	010	0	1	01	01	H9190_010_0	6	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	010	0	1	01	01	H9190_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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	010	0	1	01	01	H9190_010_0	6	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	011	0	1	01	01	H9190_011_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												
H9190	011	0	1	01	01	H9190_011_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.66	20.00	40.00	60.00																								40.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	011	0	1	01	01	H9190_011_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												
H9190	011	0	1	01	01	H9190_011_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												
H9190	011	0	1	01	01	H9190_011_0	7	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												
H9190	012	0	1	01	01	H9190_012_0	6	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	012	0	1	01	01	H9190_012_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.66	20.00	40.00	60.00																								40.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	012	0	1	01	01	H9190_012_0	6	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	012	0	1	01	01	H9190_012_0	6	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	012	0	1	01	01	H9190_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	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	015	0	1	01	01	H9190_015_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, Select Care Drugs												
H9190	015	0	1	01	01	H9190_015_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, Select Care Drugs												
H9190	015	0	1	01	01	H9190_015_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, Select Care Drugs												
H9190	015	0	1	01	01	H9190_015_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, Select Care Drugs												
H9190	015	0	1	01	01	H9190_015_0	7	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	015	0	1	01	01	H9190_015_0	7	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, Select Care Drugs												
H9190	016	0	1	01	01	H9190_016_0	7	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	016	0	1	01	01	H9190_016_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, Select Care Drugs												
H9190	016	0	1	01	01	H9190_016_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, Select Care Drugs												
H9190	016	0	1	01	01	H9190_016_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, Select Care Drugs												
H9190	016	0	1	01	01	H9190_016_0	7	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, Select Care Drugs												
H9190	016	0	1	01	01	H9190_016_0	7	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	017	0	1	01	01	H9190_017_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												
H9190	017	0	1	01	01	H9190_017_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												
H9190	017	0	1	01	01	H9190_017_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.66	20.00	40.00	60.00																								40.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	017	0	1	01	01	H9190_017_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												
H9190	017	0	1	01	01	H9190_017_0	7	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												
H9190	018	0	1	01	01	H9190_018_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.66	20.00	40.00	60.00																								40.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	018	0	1	01	01	H9190_018_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												
H9190	018	0	1	01	01	H9190_018_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												
H9190	018	0	1	01	01	H9190_018_0	7	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												
H9190	018	0	1	01	01	H9190_018_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												
H9190	019	0	1	01	01	H9190_019_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.40	12.00	24.00	36.00																								24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	019	0	1	01	01	H9190_019_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.10	3.00	6.00	9.00																								6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	019	0	1	01	01	H9190_019_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												
H9190	019	0	1	01	01	H9190_019_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												
H9190	019	0	1	01	01	H9190_019_0	7	5	Specialty Tier	1	4	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												
H9190	020	0	1	01	01	H9190_020_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.40	12.00	24.00	36.00																								24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	020	0	1	01	01	H9190_020_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.10	3.00	6.00	9.00																								6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	020	0	1	01	01	H9190_020_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												
H9190	020	0	1	01	01	H9190_020_0	7	5	Specialty Tier	1	4	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												
H9190	020	0	1	01	01	H9190_020_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												
H9190	021	0	1	01	01	H9190_021_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.10	3.00	6.00	9.00																								6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	021	0	1	01	01	H9190_021_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.40	12.00	24.00	36.00																								24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	021	0	1	01	01	H9190_021_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												
H9190	021	0	1	01	01	H9190_021_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												
H9190	021	0	1	01	01	H9190_021_0	7	5	Specialty Tier	1	4	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												
H9207	002	0	1	01	01	H9207_002_0	8	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												
H9207	002	0	1	01	01	H9207_002_0	8	3	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	180.00																								180.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	002	0	1	01	01	H9207_002_0	8	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	90.00																								90.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	002	0	1	01	01	H9207_002_0	8	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.10	3.00	6.00	6.00																								6.00																		3.00				0.10	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	003	0	1	01	01	H9207_003_0	8	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												
H9207	003	0	1	01	01	H9207_003_0	8	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	90.00																								90.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	003	0	1	01	01	H9207_003_0	8	3	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	180.00																								180.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	003	0	1	01	01	H9207_003_0	8	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												
H9208	001	0	1	01	01	H9208_001_0	12	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.06	2.00	4.00	5.00																					0.06	2.00	4.00	4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	001	0	1	01	01	H9208_001_0	12	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.32	10.00	20.00	25.00																					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												
H9208	001	0	1	01	01	H9208_001_0	12	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.12	35.00	70.00	87.50																					1.12	35.00	70.00	70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	001	0	1	01	01	H9208_001_0	12	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					98.52	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	001	0	1	01	01	H9208_001_0	12	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					1322.31	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	002	0	1	01	01	H9208_002_0	12	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.06	2.00	4.00	5.00																					0.06	2.00	4.00	4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	002	0	1	01	01	H9208_002_0	12	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.32	10.00	20.00	25.00																					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												
H9208	002	0	1	01	01	H9208_002_0	12	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.12	35.00	70.00	87.50																					1.12	35.00	70.00	70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	002	0	1	01	01	H9208_002_0	12	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					97.89	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	002	0	1	01	01	H9208_002_0	12	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					1215.95	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9264	001	0	1	48	05	H9264_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	6.60	0.00	6.60			0.00	6.60			
H9264	001	0	1	48	05	H9264_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			
H9264	001	0	1	48	05	H9264_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	2.65	0.00	2.65			0.00	2.65			
H9285	001	0	1	01	01	H9285_001_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												
H9285	001	0	1	01	01	H9285_001_0	8	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		170.00																		85.00				2.74	85.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	001	0	1	01	01	H9285_001_0	8	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	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												
H9285	003	0	1	01	01	H9285_003_0	9	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	9	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	9	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												
H9285	003	0	1	01	01	H9285_003_0	9	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	003	0	1	01	01	H9302_003_0	11	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	10.00																					0.12	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	11	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.64	20.00	40.00	50.00																					0.64	20.00	40.00	40.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	11	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	112.50																					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												
H9302	003	0	1	01	01	H9302_003_0	11	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					67.23	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	11	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					1462.04	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	11	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.12	4.00	8.00	10.00																					.12	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9302	007	0	1	01	01	H9302_007_0	11	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	10.00																					0.12	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	11	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.64	20.00	40.00	50.00																					0.64	20.00	40.00	40.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	11	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	112.50																					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												
H9302	007	0	1	01	01	H9302_007_0	11	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					83.28	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	11	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					1365.51	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	11	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	10.00																					0.12	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	11	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.64	20.00	40.00	50.00																					0.64	20.00	40.00	40.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	11	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					1165.39	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	11	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					80.46	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	11	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	112.50																					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												
H9345	001	0	1	48	05	H9345_001_0	7	1	Generic Drugs	1	4	010000			110		01	110		1	30		90				1	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9345	001	0	1	48	05	H9345_001_0	7	2	Brand Drugs	1	4	000010			110		01	110		1	30		90				1	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9345	001	0	1	48	05	H9345_001_0	7	3	Non-Medicare Rx Drugs	1	4	010010			110		01	110		1	30		90				1	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			
H9345	001	0	1	48	05	H9345_001_0	7	4	Non-Medicare OTC Drugs	1	4	010010			110		01	110		1	30		90				1	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			
H9385	002	0	1	01	01	H9385_002_0	9	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	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	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	002	0	1	01	01	H9385_002_0	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	125.00																		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	9	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	9	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	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					545.39	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9412	003	0	1	04	01	H9412_003_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		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	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9412	003	0	1	04	01	H9412_003_0	7	1	Preferred Generic	3	4	001000	1	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										1		
H9412	003	0	1	04	01	H9412_003_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			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												
H9412	003	0	1	04	01	H9412_003_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.30	39.00		117.00																								117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9412	003	0	1	04	01	H9412_003_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.60	18.00		54.00																								54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9487	001	0	1	48	05	H9487_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			
H9487	001	0	1	48	05	H9487_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	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9487	001	0	1	48	05	H9487_001_0	5	2	Brand Drugs	1	4	000010			110		01	110		1	30		90				2	30		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			
H9492	001	0	1	01	01	H9492_001_0	11	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					1246.94	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9492	001	0	1	01	01	H9492_001_0	11	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					98.52	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9492	001	0	1	01	01	H9492_001_0	11	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.12	35.00	70.00	87.50																					1.12	35.00	70.00	70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9492	001	0	1	01	01	H9492_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	0.32	10.00	20.00	25.00																					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												
H9492	001	0	1	01	01	H9492_001_0	11	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.06	2.00	4.00	5.00																					0.06	2.00	4.00	4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9525	003	0	1	01	01	H9525_003_0	12	1	Preferred Generic	1	3	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	15.00					0.16	5.00	10.00	10.00																		5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	12	5	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, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	12	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					1.00	30.00	60.00	90.00					1.00	30.00	90.00	90.00																		30.00				0.88	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	12	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.13	94.00	188.00	282.00					2.96	89.00	178.00	267.00					2.96	89.00	267.00	267.00																		94.00				2.76	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	12	2	Non-Preferred Generic	1	3	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	30.00					0.33	10.00	20.00	20.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	12	6	Select Care Drugs	1	3	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												
H9525	004	0	1	01	01	H9525_004_0	11	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.70	21.00	42.00	63.00					0.53	16.00	32.00	48.00					0.53	16.00	32.00	32.00																		21.00				0.61	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	11	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	11	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	11	5	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, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	11	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	11	6	Select Care Drugs	1	3	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												
H9525	005	0	1	01	01	H9525_005_0	11	6	Select Care Drugs	1	3	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												
H9525	005	0	1	01	01	H9525_005_0	11	5	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, Specialty Tier, Select Care Drugs												
H9525	005	0	1	01	01	H9525_005_0	11	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	005	0	1	01	01	H9525_005_0	11	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	005	0	1	01	01	H9525_005_0	11	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	005	0	1	01	01	H9525_005_0	11	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.76	23.00	46.00	69.00					0.60	18.00	36.00	54.00					0.60	18.00	36.00	36.00																		23.00				0.67	23.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9572	001	1	1	04	01	H9572_001_1	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	30							1.00	30							30																			30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_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		285.00					3.06	95.00		237.50					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	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.51	16.00		48.00					.51	16.00		40.00					.51	16.00		40.00																		16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	11	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		112.50					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	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.51	16.00		48.00					.51	16.00		40.00					.51	16.00		40.00																		16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	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		285.00					3.06	95.00		237.50					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	2	1	04	01	H9572_001_2	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	30							1.00	30							30																			30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	11	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		112.50					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	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	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		285.00					3.06	95.00		237.50					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	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.51	16.00		48.00					.51	16.00		40.00					.51	16.00		40.00																		16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	11	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		112.50					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	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	30							1.00	30							30																			30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.51	16.00		48.00					.51	16.00		40.00					.51	16.00		40.00																		16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	11	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		112.50					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	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	30							1.00	30							30																			30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	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		285.00					3.06	95.00		237.50					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	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	30							1.00	30							30																			30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	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		285.00					3.06	95.00		237.50					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	11	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		112.50					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	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.51	16.00		48.00					.51	16.00		40.00					.51	16.00		40.00																		16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		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									.38	12.00		36.00					.38	12.00		30.00					.38	12.00		30.00																		12.00				.38	12.00		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		120.00					1.29	40.00		100.00					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	4	Non-Preferred Brand	1	4	100000	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					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	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	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	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	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	11	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9572	003	2	1	04	01	H9572_003_2	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	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.38	12.00		36.00					.38	12.00		30.00					.38	12.00		30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	11	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		100.00					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	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		285.00					3.06	95.00		237.50					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	11	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9572	003	3	1	04	01	H9572_003_3	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.38	12.00		36.00					.38	12.00		30.00					.38	12.00		30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	11	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		100.00					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	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		285.00					3.06	95.00		237.50					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	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	3	1	04	01	H9572_003_3	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	11	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		100.00					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	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		285.00					3.06	95.00		237.50					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	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	4	1	04	01	H9572_003_4	11	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9572	003	4	1	04	01	H9572_003_4	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.38	12.00		36.00					.38	12.00		30.00					.38	12.00		30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.38	12.00		36.00					.38	12.00		30.00					.38	12.00		30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	11	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.09	3.00		7.50					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9572	003	6	1	04	01	H9572_003_6	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		285.00					3.06	95.00		237.50					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	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	6	1	04	01	H9572_003_6	11	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		100.00					1.29	40.00		100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_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												
H9615	007	0	1	04	01	H9615_007_0	7	3	Preferred Brand	1	4	000101	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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_0	7	4	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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				2	30		90				30		31					50.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_0	7	6	Vaccines	1	4	010010	1	2	010		01	010		1	30							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												
H9615	007	0	1	04	01	H9615_007_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9615	007	0	1	04	01	H9615_007_0	7	6	Vaccines	3	4	010010	1	2	010		01	010		1	30							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		
H9689	001	0	1	01	01	H9689_001_0	3	1	Preferred Generic	1	2	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		12.00					.13	4.00		8.00					.13	4.00		12.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9689	001	0	1	01	01	H9689_001_0	3	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												
H9689	001	0	1	01	01	H9689_001_0	3	4	Non-Preferred Brand	1	2	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												
H9689	001	0	1	01	01	H9689_001_0	3	3	Preferred Brand	1	2	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												
H9689	001	0	1	01	01	H9689_001_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		30.00					.33	10.00		20.00					.33	10.00		30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	001	0	1	01	01	H9699_001_0	12	4	Non-Preferred Brand	1	4	110000	1	1		110	01	110		1				30		90	1	30		90				30		31													36.47	33		33					31.08	30		30					30		30																	33				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	001	0	1	01	01	H9699_001_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		90.00					1.33	40.00		80.00					1.33	40.00		80.00																		45.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	001	0	1	01	01	H9699_001_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		66.00					.46	14.00		28.00					.46	14.00		28.00																		33.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	001	0	1	01	01	H9699_001_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		20.00					.10	3.00		6.00					.10	3.00		6.00																		10.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	001	0	1	01	01	H9699_001_0	12	5	Specialty Tier	1	4	010010	1	1		110	01	110		1				30		90	1	30		90				30		31													585.19	25		25					351.87	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9712	001	0	1	48	05	H9712_001_0	5	1	Generic Drugs	1	4	010000			010		01			1	30													30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00			0.00	0.00			
H9712	001	0	1	48	05	H9712_001_0	5	2	Brand Drugs	1	4	000010			010		01			1	30													30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00			0.00	0.00			
H9725	001	0	1	01	01	H9725_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00		255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					548.26	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	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		9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9725	001	0	1	01	01	H9725_001_0	4	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9725	001	0	1	01	01	H9725_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		135.00																		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	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		9.00																		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	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		36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.33	10.00		30.00					0.16	5.00		15.00												0.33	10.00		30.00				0.16	5.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_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		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									1.00	30.00		90.00					0.50	15.00		45.00												1.00	30.00		90.00				0.50	15.00		37.50				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.83	85.00		255.00												3.16	95.00		285.00				2.83	85.00		212.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					.83	25.00		75.00												1.50	45.00		135.00				.83	25.00		62.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.46	14.00		42.00					.06	2.00		6.00												.46	14.00		42.00				.06	2.00		5.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					0.00	0.00		0.00												.33	10.00		30.00				0.00	0.00		0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	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		285.00					2.56	77.00		231.00												3.16	95.00		285.00				2.56	77.00		192.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9795	001	0	1	48	05	H9795_001_0	9	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		01			1	30													30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H9795	001	0	1	48	05	H9795_001_0	9	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				1			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			
H9795	001	0	1	48	05	H9795_001_0	9	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				1			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			
H9834	001	0	1	01	01	H9834_001_0	4	2	Non-Preferred Generic	1	3	000100	1	2	111		01			1	30	60	90				1							30		31	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												
H9834	001	0	1	01	01	H9834_001_0	4	1	Preferred Generic	1	3	001000	1	2	111		01			1	30	60	90				1							30		31	.30	9.00	18.00	27.00																																										9.00				.29	9.00		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					1251.88	30																																										30				30	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	111		01			1	30	60	90				1							30		31	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												
H9834	001	0	1	01	01	H9834_001_0	4	3	Preferred Brand	1	3	000001	1	2	111		01			1	30	60	90				1							30		31	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												
H9834	003	0	1	01	01	H9834_003_0	3	4	Non-Preferred Brand	1	3	100000	1	2	111		01			1	30	60	90				1							30		31	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												
H9834	003	0	1	01	01	H9834_003_0	3	2	Non-Preferred Generic	1	3	000100	1	2	111		01			1	30	60	90				1							30		31	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												
H9834	003	0	1	01	01	H9834_003_0	3	3	Preferred Brand	1	3	000001	1	2	111		01			1	30	60	90				1							30		31	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												
H9834	003	0	1	01	01	H9834_003_0	3	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31					1320.78	28																																										28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	3	1	Preferred Generic	1	3	001000	1	2	111		01			1	30	60	90				1							30		31	0.30	9.00	18.00	27.00																																										9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	001	0	1	04	01	H9847_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.90	27.00	54.00	81.00					.73	22.00	44.00	66.00					.73	22.00	44.00	66.00																			27.00			.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	001	0	1	04	01	H9847_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.30	9.00	18.00	27.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																			9.00			.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	001	0	1	04	01	H9847_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	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	7	3	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	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												
H9847	001	0	1	04	01	H9847_001_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													48.44	50	50	50					44.97	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	005	0	1	04	01	H9847_005_0	9	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	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	9	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.33	10.00	20.00	30.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	005	0	1	04	01	H9847_005_0	9	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									.70	21.00	42.00	63.00					.46	14.00	28.00	42.00					.46	14.00	28.00	42.00																			21.00			.67	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	005	0	1	04	01	H9847_005_0	9	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													48.88	50	50	50					46.94	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	005	0	1	04	01	H9847_005_0	9	3	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	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	5	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	5	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																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9857	001	0	1	01	01	H9857_001_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												
H9857	001	0	1	01	01	H9857_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						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	5	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	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												
H9859	002	0	1	02	01	H9859_002_0	8	6	Vaccines	3	4	010010	1	2	010		01	010		1	30							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		
H9859	002	0	1	02	01	H9859_002_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9859	002	0	1	02	01	H9859_002_0	8	6	Vaccines	1	4	010010	1	2	010		01	010		1	30							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												
H9859	002	0	1	02	01	H9859_002_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				2	30		90				30		31					50.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	002	0	1	02	01	H9859_002_0	8	4	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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	002	0	1	02	01	H9859_002_0	8	3	Preferred Brand	1	4	000101	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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	002	0	1	02	01	H9859_002_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	002	0	1	02	01	H9859_002_0	8	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												
H9859	013	0	1	02	01	H9859_013_0	9	6	Vaccines	1	4	010010	1	2	010		01	010		1	30							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												
H9859	013	0	1	02	01	H9859_013_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.10	3.00		9.00																					0.10	3.00		6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9859	013	0	1	02	01	H9859_013_0	9	6	Vaccines	3	4	010010	1	2	010		01	010		1	30							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		
H9859	013	0	1	02	01	H9859_013_0	9	4	Non-Preferred Brand	1	4	100100	1	2	110		01	110		1	30		90				2	30		90				30		31	3.17	95.00		285.00																					3.17	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	013	0	1	02	01	H9859_013_0	9	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				2	30		90				30		31	1.45	45.00		135.00																					1.50	45.00		90.00																		45.00				1.13	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	013	0	1	02	01	H9859_013_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.10	3.00		9.00																					0.10	3.00		6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	013	0	1	02	01	H9859_013_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				2	30		90				30		31					50.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	013	0	1	02	01	H9859_013_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.48	15.00		45.00																					0.50	15.00		30.00																		15.00				.32	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9886	003	0	1	01	01	H9886_003_0	13	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.16	5.00	10.00	15.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	003	0	1	01	01	H9886_003_0	13	2	Non-Preferred Generic	1	3	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	30.00					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	003	0	1	01	01	H9886_003_0	13	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					1.00	30.00	60.00	90.00					1.00	30.00	90.00	90.00																		30.00				.88	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	003	0	1	01	01	H9886_003_0	13	5	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, Specialty Tier, Select Care Drugs												
H9886	003	0	1	01	01	H9886_003_0	13	6	Select Care Drugs	1	3	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												
H9886	003	0	1	01	01	H9886_003_0	13	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	004	0	1	01	01	H9886_004_0	15	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					0.43	13.00	26.00	39.00					0.43	13.00	26.00	26.00																		18.00				0.52	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	004	0	1	01	01	H9886_004_0	15	6	Select Care Drugs	1	3	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												
H9886	004	0	1	01	01	H9886_004_0	15	5	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, Specialty Tier, Select Care Drugs												
H9886	004	0	1	01	01	H9886_004_0	15	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.30	9.00	18.00	27.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	004	0	1	01	01	H9886_004_0	15	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	004	0	1	01	01	H9886_004_0	15	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9915	001	0	1	01	01	H9915_001_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						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	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	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	001	0	1	01	01	H9915_001_0	8	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																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	001	0	1	01	01	H9915_001_0	8	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																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	001	0	1	01	01	H9915_001_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												
H9915	007	0	1	01	01	H9915_007_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_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, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_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, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_0	5	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																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_0	5	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																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_0	5	6	Select Diabetic Drugs	1	4	010010	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																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	008	0	1	01	01	H9915_008_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	008	0	1	01	01	H9915_008_0	6	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												
H9915	008	0	1	01	01	H9915_008_0	6	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												
H9915	008	0	1	01	01	H9915_008_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.33	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												
H9915	008	0	1	01	01	H9915_008_0	6	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																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	010	0	1	01	01	H9915_010_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	6	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, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	6	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, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.33	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, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	6	6	Select Diabetic Drugs	1	4	010010	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																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	6	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																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9947	005	1	1	04	01	H9947_005_1	13	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	1	1	04	01	H9947_005_1	13	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.70	21.00	42.00	63.00					0.53	16.00	32.00	48.00					0.53	16.00	32.00	32.00																		21.00				0.61	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	1	1	04	01	H9947_005_1	13	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	1	1	04	01	H9947_005_1	13	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	1	1	04	01	H9947_005_1	13	6	Select Care Drugs	1	3	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												
H9947	005	1	1	04	01	H9947_005_1	13	5	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, Specialty Tier, Select Care Drugs												
H9947	005	2	1	04	01	H9947_005_2	13	5	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, Specialty Tier, Select Care Drugs												
H9947	005	2	1	04	01	H9947_005_2	13	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	2	1	04	01	H9947_005_2	13	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	2	1	04	01	H9947_005_2	13	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.70	21.00	42.00	63.00					0.53	16.00	32.00	48.00					0.53	16.00	32.00	32.00																		21.00				0.61	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	2	1	04	01	H9947_005_2	13	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	2	1	04	01	H9947_005_2	13	6	Select Care Drugs	1	3	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												
H9954	002	0	1	01	01	H9954_002_0	14	5	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, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_002_0	14	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_002_0	14	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.40	42.00	84.00	126.00					1.23	37.00	74.00	111.00					1.23	37.00	111.00	111.00																		42.00				1.23	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_002_0	14	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.96	29.00	58.00	87.00					.80	24.00	48.00	72.00					.80	24.00	48.00	48.00																		29.00				.85	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_002_0	14	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_002_0	14	6	Select Care Drugs	1	3	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												
H9954	004	0	1	01	01	H9954_004_0	12	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.16	5.00	10.00	15.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	004	0	1	01	01	H9954_004_0	12	2	Non-Preferred Generic	1	3	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	30.00					.33	10.00	20.00	20.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	004	0	1	01	01	H9954_004_0	12	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					1.00	30.00	60.00	90.00					1.00	30.00	90.00	90.00																		30.00				.88	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	004	0	1	01	01	H9954_004_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	004	0	1	01	01	H9954_004_0	12	5	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, Specialty Tier, Select Care Drugs												
H9954	004	0	1	01	01	H9954_004_0	12	6	Select Care Drugs	1	3	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												
H9954	005	0	1	01	01	H9954_005_0	15	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.33	10.00	20.00	30.00					.16	5.00	10.00	15.00					.16	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	005	0	1	01	01	H9954_005_0	15	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.83	25.00	50.00	75.00					.66	20.00	40.00	60.00					.66	20.00	40.00	40.00																		25.00				.73	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	005	0	1	01	01	H9954_005_0	15	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	005	0	1	01	01	H9954_005_0	15	5	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, Specialty Tier, Select Care Drugs												
H9954	005	0	1	01	01	H9954_005_0	15	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					2.73	82.00	164.00	246.00					2.73	82.00	246.00	246.00																		87.00				2.55	87.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	005	0	1	01	01	H9954_005_0	15	6	Select Care Drugs	1	3	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												
R3332	001	0	1	31	11	R3332_001_0	11	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					.90	28.00		84.00					.90	28.00		84.00																		33.00				.90	28.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	11	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.32	10.00		30.00					.16	5.00		15.00					.16	5.00		15.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	11	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					1.29	40.00		120.00					1.29	40.00		120.00																		45.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	11	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					2.90	90.00		270.00					2.90	90.00		270.00																		95.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	11	5	Specialty Tier	1	3	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													456.20	25		25					456.20	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	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.30	9.00		27.00																															27.00							18.00				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	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															9.00							6.00				3.00				.09	3.00		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	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															135.00							125.00				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	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					704.00	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	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															285.00							275.00				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	4	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							8.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_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							22.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_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							275.00				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	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							125.00				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	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					804.00	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	3	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							125.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5287	001	0	1	31	11	R5287_001_0	3	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							275.00				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	3	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5287	001	0	1	31	11	R5287_001_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5287	001	0	1	31	11	R5287_001_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					647.00	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	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				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	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	2	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							125.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					663.00	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	2	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							275.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	3	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		12.00				0.13	4.00		0.00				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	3	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		21.00				0.23	7.00		0.00				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	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		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												
R5826	001	0	1	31	11	R5826_001_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		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												
R5826	001	0	1	31	11	R5826_001_0	3	5	Specialty Tier	1	3	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												
R5826	002	0	1	31	11	R5826_002_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		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												
R5826	002	0	1	31	11	R5826_002_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		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												
R5826	002	0	1	31	11	R5826_002_0	3	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		54.00				0.60	18.00		0.00				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	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		21.00				0.23	7.00		0.00				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	5	Specialty Tier	1	3	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												
R5826	005	0	1	31	11	R5826_005_0	3	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		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												
R5826	005	0	1	31	11	R5826_005_0	3	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		24.00				0.26	8.00		0.00				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	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	005	0	1	31	11	R5826_005_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		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										2	3	
R5826	005	0	1	31	11	R5826_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		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										2	3	
R5826	005	0	1	31	11	R5826_005_0	3	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		24.00				0.26	8.00		0.00				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	3	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		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										2	3	
R5826	005	0	1	31	11	R5826_005_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_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		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												
R5826	005	0	1	31	11	R5826_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		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												
R5826	007	0	1	31	11	R5826_007_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		33.00				0.36	11.00		0.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_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		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												
R5826	007	0	1	31	11	R5826_007_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		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												
R5826	007	0	1	31	11	R5826_007_0	4	5	Specialty Tier	1	3	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												
R5826	007	0	1	31	11	R5826_007_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		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	1	3	010010	1	1	010		01		010	1	30										30			30		31						27																														27							27					27				27	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	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.63	19.00		57.00																												0.63	19.00		57.00				0.63	19.00		0.00				19.00				0.61	19.00		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	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		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												
R5826	008	0	1	31	11	R5826_008_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		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												
R5826	008	0	1	31	11	R5826_008_0	3	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_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		270.00				3.00	90.00		260.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	5	5	Specialty Tier	1	3	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												
R5826	011	0	1	31	11	R5826_011_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		15.00				0.16	5.00		0.00				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	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.46	14.00		42.00																												0.46	14.00		42.00				0.46	14.00		0.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_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		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												
R5826	012	0	1	31	11	R5826_012_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		36.00				0.40	12.00		0.00				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	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		21.00				0.23	7.00		0.00				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	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		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												
R5826	012	0	1	31	11	R5826_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		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												
R5826	012	0	1	31	11	R5826_012_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31						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	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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	012	0	1	31	11	R5826_012_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		36.00				0.40	12.00		0.00				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	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		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										2	3	
R5826	012	0	1	31	11	R5826_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		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										2	3	
R5826	012	0	1	31	11	R5826_012_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31						33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_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		36.00				0.40	12.00		0.00				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	3	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		18.00				0.20	6.00		0.00				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	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		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												
R5826	014	0	1	31	11	R5826_014_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						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	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		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												
R5826	074	0	1	31	11	R5826_074_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		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	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		45.00				0.50	15.00		0.00				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	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		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												
R5826	074	0	1	31	11	R5826_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		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												
R5826	074	0	1	31	11	R5826_074_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_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		15.00				0.16	5.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	4	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		51.00				0.56	17.00		0.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_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		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												
R5826	077	0	1	31	11	R5826_077_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		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												
R5826	077	0	1	31	11	R5826_077_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31						28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	079	0	1	31	11	R5826_079_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		21.00				0.23	7.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	079	0	1	31	11	R5826_079_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		60.00				0.66	20.00		0.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	079	0	1	31	11	R5826_079_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		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												
R5826	079	0	1	31	11	R5826_079_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		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												
R5826	079	0	1	31	11	R5826_079_0	5	5	Specialty Tier	1	3	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												
R5826	091	0	1	31	11	R5826_091_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	091	0	1	31	11	R5826_091_0	3	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		39.00				0.43	13.00		0.00				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	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		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												
R5826	091	0	1	31	11	R5826_091_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		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												
R5826	091	0	1	31	11	R5826_091_0	3	5	Specialty Tier	1	4	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												
R5826	091	0	1	31	11	R5826_091_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		18.00				0.20	6.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	3	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		39.00				0.43	13.00		0.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	091	0	1	31	11	R5826_091_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		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										2	3	
R5826	091	0	1	31	11	R5826_091_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		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										2	3	
R5826	091	0	1	31	11	R5826_091_0	3	5	Specialty Tier	3	4	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										2	3	
R5941	014	0	1	31	11	R5941_014_0	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	12	5	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, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	12	6	Select Care Drugs	1	3	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												
R5941	014	0	1	31	11	R5941_014_0	12	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	12	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.73	22.00	44.00	66.00					0.56	17.00	34.00	51.00					0.56	17.00	34.00	34.00																		22.00				0.64	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_0	12	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_0	12	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					3.00	90.00	180.00	270.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_0	12	5	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, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_0	12	6	Select Care Drugs	1	3	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												
R5941	015	0	1	31	11	R5941_015_0	12	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.33	10.00	20.00	30.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_0	12	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.66	20.00	40.00	60.00					0.50	15.00	30.00	45.00					0.50	15.00	30.00	30.00																		20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R6801	008	0	1	31	11	R6801_008_0	3	2	Non-Preferred Generic	1	4	000100	1	1	110		01	100		1	30		90				1			90				30		31					5.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	008	0	1	31	11	R6801_008_0	3	3	Preferred Brand	1	4	010001	1	1	110		01	100		1	30		90				1			90				30		31					48.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	008	0	1	31	11	R6801_008_0	3	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					514.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	008	0	1	31	11	R6801_008_0	3	4	Non-Preferred Brand	1	4	100100	1	1	110		01	100		1	30		90				1			90				30		31					27.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	008	0	1	31	11	R6801_008_0	3	1	Preferred Generic	1	4	001000	1	1	110		01	100		1	30		90				1			90				30		31					4.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					671.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_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							275.00				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	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							125.00				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	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															9.00							6.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_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																															30.00							20.00				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	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					761.00	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	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							275.00				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	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							125.00				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	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.40	12.00		36.00																															36.00							24.00				12.00				.38	12.00		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	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															9.00							6.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															24.00							16.00				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	2	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							125.00				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	2	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							275.00				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	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					652.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.06	2.00		6.00																															6.00							4.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	009	0	1	31	11	R9896_009_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																															9.00							6.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	009	0	1	31	11	R9896_009_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							18.00				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	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																															135.00							125.00				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	5	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					661.00	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	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																															285.00							275.00				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	5	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															9.00							6.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	012	0	1	31	11	R9896_012_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.43	13.00		39.00																															39.00							26.00				13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	012	0	1	31	11	R9896_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																															135.00							125.00				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	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																															285.00							275.00				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	5	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					709.00	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	3	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	001	0		29	10	S0064_001_0	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.29	9.00		27.00					.09	3.00		9.00																										9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	001	0		29	10	S0064_001_0	3	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	001	0		29	10	S0064_001_0	3	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													94.26	40		40					94.96	38		38																								40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	001	0		29	10	S0064_001_0	3	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													31.08	25		25					30.89	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	002	0		29	10	S0064_002_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													31.27	25		25					29.30	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	002	0		29	10	S0064_002_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													94.00	41		41					88.88	39		39																								41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	002	0		29	10	S0064_002_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	002	0		29	10	S0064_002_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.32	10.00		30.00					.12	4.00		12.00																										10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	002	0		29	10	S0064_002_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	003	0		29	10	S0064_003_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	003	0		29	10	S0064_003_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													94.05	42		42					90.33	40		40																								42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	003	0		29	10	S0064_003_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	003	0		29	10	S0064_003_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.35	11.00		33.00					.16	5.00		15.00																										11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	003	0		29	10	S0064_003_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													34.11	25		25					31.89	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	004	0		29	10	S0064_004_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	004	0		29	10	S0064_004_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													94.98	45		45					91.74	43		43																								45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	004	0		29	10	S0064_004_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	004	0		29	10	S0064_004_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.29	9.00		27.00					.09	3.00		9.00																										9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	004	0		29	10	S0064_004_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													31.08	25		25					29.13	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	005	0		29	10	S0064_005_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	005	0		29	10	S0064_005_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													91.06	50		50					89.17	48		48																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	005	0		29	10	S0064_005_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	005	0		29	10	S0064_005_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.25	8.00		24.00					.06	2.00		6.00																										8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	005	0		29	10	S0064_005_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													25.67	22		22					22.96	20		20																								22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	006	0		29	10	S0064_006_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	006	0		29	10	S0064_006_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.07	45		45					103.14	43		43																								45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	006	0		29	10	S0064_006_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	006	0		29	10	S0064_006_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.25	8.00		24.00					.06	2.00		6.00																										8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	006	0		29	10	S0064_006_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													29.30	24		24					26.46	22		22																								24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	007	0		29	10	S0064_007_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	007	0		29	10	S0064_007_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.97	42		42					89.52	40		40																								42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	007	0		29	10	S0064_007_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	007	0		29	10	S0064_007_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.35	11.00		33.00					.16	5.00		15.00																										11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	007	0		29	10	S0064_007_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													31.63	25		25					29.48	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	008	0		29	10	S0064_008_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	008	0		29	10	S0064_008_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.12	47		47					88.99	45		45																								47				47	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	008	0		29	10	S0064_008_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	008	0		29	10	S0064_008_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.35	11.00		33.00					.16	5.00		15.00																										11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	008	0		29	10	S0064_008_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													32.92	25		25					30.32	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	009	0		29	10	S0064_009_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	009	0		29	10	S0064_009_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													85.47	50		50					86.08	48		48																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	009	0		29	10	S0064_009_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	009	0		29	10	S0064_009_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.25	8.00		24.00					.06	2.00		6.00																										8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	009	0		29	10	S0064_009_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													24.08	20		20					22.92	18		18																								20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	010	0		29	10	S0064_010_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	010	0		29	10	S0064_010_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													74.69	50		50					73.40	48		48																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	010	0		29	10	S0064_010_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	010	0		29	10	S0064_010_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.32	10.00		30.00					.12	4.00		12.00																										10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	010	0		29	10	S0064_010_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													30.98	25		25					29.57	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	011	0		29	10	S0064_011_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													38.50	25		25					35.40	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	011	0		29	10	S0064_011_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	011	0		29	10	S0064_011_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.38	12.00		36.00					.19	6.00		18.00																										12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	011	0		29	10	S0064_011_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.62	43		43					89.16	41		41																								43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	011	0		29	10	S0064_011_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														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	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		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	000110	1	2		110	01			1				31		90	2							31		31									.41	13.00		39.00					.22	7.00		21.00																										13.00				.41	13.00		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	1		110	01			1				31		90	2							31		31													36.59	25		25					33.98	23		23																								25				25	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		010	01			1				31										31		31														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	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.65	43		43					83.65	41		41																								43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	013	0		29	10	S0064_013_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	013	0		29	10	S0064_013_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	013	0		29	10	S0064_013_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.35	11.00		33.00					.16	5.00		15.00																										11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	013	0		29	10	S0064_013_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													31.12	25		25					28.71	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	013	0		29	10	S0064_013_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													94.54	45		45					90.70	43		43																								45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	014	0		29	10	S0064_014_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													32.32	25		25					30.81	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	014	0		29	10	S0064_014_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.35	11.00		33.00					.16	5.00		15.00																										11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	014	0		29	10	S0064_014_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	014	0		29	10	S0064_014_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	014	0		29	10	S0064_014_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.95	43		43					82.99	41		41																								43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	015	0		29	10	S0064_015_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	015	0		29	10	S0064_015_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													33.43	25		25					30.92	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	015	0		29	10	S0064_015_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.56	47		47					89.88	45		45																								47				47	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	015	0		29	10	S0064_015_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	015	0		29	10	S0064_015_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.29	9.00		27.00					.09	3.00		9.00																										9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	016	0		29	10	S0064_016_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	016	0		29	10	S0064_016_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													29.95	25		25					27.62	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	016	0		29	10	S0064_016_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													94.21	43		43					88.76	41		41																								43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	016	0		29	10	S0064_016_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.35	11.00		33.00					.16	5.00		15.00																										11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	016	0		29	10	S0064_016_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	017	0		29	10	S0064_017_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	017	0		29	10	S0064_017_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													94.44	46		46					89.62	44		44																								46				46	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	017	0		29	10	S0064_017_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													29.83	25		25					28.25	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	017	0		29	10	S0064_017_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.35	11.00		33.00					.16	5.00		15.00																										11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	017	0		29	10	S0064_017_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	018	0		29	10	S0064_018_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	018	0		29	10	S0064_018_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													36.90	25		25					33.39	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	018	0		29	10	S0064_018_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													92.84	41		41					86.32	39		39																								41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	018	0		29	10	S0064_018_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.38	12.00		36.00					.19	6.00		18.00																										12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	018	0		29	10	S0064_018_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	019	0		29	10	S0064_019_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	019	0		29	10	S0064_019_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.35	11.00		33.00					.16	5.00		15.00																										11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	019	0		29	10	S0064_019_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													35.30	25		25					32.76	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	019	0		29	10	S0064_019_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.71	47		47					85.90	45		45																								47				47	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	019	0		29	10	S0064_019_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	020	0		29	10	S0064_020_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	020	0		29	10	S0064_020_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.29	9.00		27.00					.09	3.00		9.00																										9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	020	0		29	10	S0064_020_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													38.05	25		25					33.49	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	020	0		29	10	S0064_020_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.88	50		50					84.51	48		48																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	020	0		29	10	S0064_020_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	021	0		29	10	S0064_021_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													38.43	25		25					35.53	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	021	0		29	10	S0064_021_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	021	0		29	10	S0064_021_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													94.28	45		45					87.95	43		43																								45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	021	0		29	10	S0064_021_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.29	9.00		27.00					.09	3.00		9.00																										9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	021	0		29	10	S0064_021_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	022	0		29	10	S0064_022_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	022	0		29	10	S0064_022_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.32	10.00		30.00					.12	4.00		12.00																										10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	022	0		29	10	S0064_022_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	022	0		29	10	S0064_022_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													94.64	46		46					86.64	44		44																								46				46	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	022	0		29	10	S0064_022_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													34.70	25		25					32.06	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	023	0		29	10	S0064_023_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	023	0		29	10	S0064_023_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													94.62	47		47					90.25	45		45																								47				47	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	023	0		29	10	S0064_023_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	023	0		29	10	S0064_023_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.25	8.00		24.00					.06	2.00		6.00																										8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	023	0		29	10	S0064_023_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													31.55	25		25					28.79	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	024	0		29	10	S0064_024_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													33.22	25		25					32.54	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	024	0		29	10	S0064_024_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.41	13.00		39.00					.22	7.00		21.00																										13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	024	0		29	10	S0064_024_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													92.67	37		37					84.51	35		35																								37				37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	024	0		29	10	S0064_024_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	024	0		29	10	S0064_024_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	025	0		29	10	S0064_025_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.41	13.00		39.00					.22	7.00		21.00																										13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	025	0		29	10	S0064_025_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	025	0		29	10	S0064_025_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													28.76	25		25					26.80	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	025	0		29	10	S0064_025_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	025	0		29	10	S0064_025_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													92.96	41		41					88.44	39		39																								41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	026	0		29	10	S0064_026_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.41	13.00		39.00					.22	7.00		21.00																										13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	026	0		29	10	S0064_026_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	026	0		29	10	S0064_026_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													32.86	25		25					30.79	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	026	0		29	10	S0064_026_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	026	0		29	10	S0064_026_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.03	45		45					84.81	43		43																								45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	027	0		29	10	S0064_027_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	027	0		29	10	S0064_027_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													25.58	25		25					24.06	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	027	0		29	10	S0064_027_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.35	11.00		33.00					.16	5.00		15.00																										11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	027	0		29	10	S0064_027_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	027	0		29	10	S0064_027_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													94.32	40		40					84.88	38		38																								40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	028	0		29	10	S0064_028_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	028	0		29	10	S0064_028_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.25	8.00		24.00					.06	2.00		6.00																										8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	028	0		29	10	S0064_028_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													30.66	24		24					28.57	22		22																								24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	028	0		29	10	S0064_028_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	028	0		29	10	S0064_028_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													84.82	50		50					86.92	48		48																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	029	0		29	10	S0064_029_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.55	47		47					88.92	45		45																								47				47	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	029	0		29	10	S0064_029_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	029	0		29	10	S0064_029_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	029	0		29	10	S0064_029_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													32.31	25		25					32.05	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	029	0		29	10	S0064_029_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.35	11.00		33.00					.16	5.00		15.00																										11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	030	0		29	10	S0064_030_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.62	41		41					88.77	39		39																								41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	030	0		29	10	S0064_030_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													32.01	25		25					29.80	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	030	0		29	10	S0064_030_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.32	10.00		30.00					.12	4.00		12.00																										10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	030	0		29	10	S0064_030_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	030	0		29	10	S0064_030_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	031	0		29	10	S0064_031_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	031	0		29	10	S0064_031_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.32	10.00		30.00					.12	4.00		12.00																										10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	031	0		29	10	S0064_031_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													32.20	25		25					29.29	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	031	0		29	10	S0064_031_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.70	43		43					88.52	41		41																								43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	031	0		29	10	S0064_031_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	032	0		29	10	S0064_032_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.59	46		46					89.34	44		44																								46				46	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	032	0		29	10	S0064_032_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													33.15	25		25					30.41	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	032	0		29	10	S0064_032_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.35	11.00		33.00					.16	5.00		15.00																										11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	032	0		29	10	S0064_032_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	032	0		29	10	S0064_032_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	033	0		29	10	S0064_033_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.35	11.00		33.00					.16	5.00		15.00																										11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	033	0		29	10	S0064_033_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	033	0		29	10	S0064_033_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													40.73	25		25					38.01	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	033	0		29	10	S0064_033_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.54	39		39					88.34	37		37																								39				39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	033	0		29	10	S0064_033_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	034	0		29	10	S0064_034_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.25	8.00		24.00					.06	2.00		6.00																										8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	034	0		29	10	S0064_034_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	034	0		29	10	S0064_034_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													25.35	19		19					22.84	17		17																								19				19	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	034	0		29	10	S0064_034_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	034	0		29	10	S0064_034_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													83.13	50		50					79.94	48		48																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	035	0		29	10	S0064_035_0	2	1	Preferred Generic	1	2	001010	1	2		110	01			1				31		90	2							31		31									.09	3.00		9.00					0.00	0.00		0.00																										3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	035	0		29	10	S0064_035_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01			1				31		90	2							31		31									.45	14.00		42.00					.25	8.00		24.00																										14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	035	0		29	10	S0064_035_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01			1				31		90	2							31		31													93.63	46		46					89.56	44		44																								46				46	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	035	0		29	10	S0064_035_0	2	3	Preferred Brand	1	2	010001	1	1		110	01			1				31		90	2							31		31													35.92	25		25					33.05	23		23																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	035	0		29	10	S0064_035_0	2	5	Specialty Tier	1	2	010010	1	1		010	01			1				31										31		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.83	55.00	110.00	165.00					1.66	50.00	100.00	150.00					1.66	50.00	100.00	150.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	1	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												
S0522	002	0		29	10	S0522_002_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	1	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												
S0522	004	0		29	10	S0522_004_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	1	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												
S0522	004	0		29	10	S0522_004_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.16	65.00	130.00	195.00					2.00	60.00	120.00	180.00					2.00	60.00	120.00	180.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	1	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												
S0522	006	0		29	10	S0522_006_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.33	70.00	140.00	210.00					2.16	65.00	130.00	195.00					2.16	65.00	130.00	195.00																		70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.16	65.00	130.00	195.00					2.00	60.00	120.00	180.00					2.00	60.00	120.00	180.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	1	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												
S0522	010	0		29	10	S0522_010_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	1	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												
S0522	010	0		29	10	S0522_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									1.83	55.00	110.00	165.00					1.66	50.00	100.00	150.00					1.66	50.00	100.00	150.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	1	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.00	30.00	60.00	90.00					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	010	0		29	10	S0522_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									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	1	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												
S0522	012	0		29	10	S0522_012_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.83	55.00	110.00	165.00					1.66	50.00	100.00	150.00					1.66	50.00	100.00	150.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	1	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												
S0522	014	0		29	10	S0522_014_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.16	65.00	130.00	195.00					2.00	60.00	120.00	180.00					2.00	60.00	120.00	180.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.16	65.00	130.00	195.00					2.00	60.00	120.00	180.00					2.00	60.00	120.00	180.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	1	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												
S0522	016	0		29	10	S0522_016_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	1	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												
S0522	018	0		29	10	S0522_018_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.33	70.00	140.00	210.00					2.16	65.00	130.00	195.00					2.16	65.00	130.00	195.00																		70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.00	60.00	120.00	180.00					1.83	55.00	110.00	165.00					1.83	55.00	110.00	165.00																		60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	1	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												
S0522	020	0		29	10	S0522_020_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.00	60.00	120.00	180.00					1.83	55.00	110.00	165.00					1.83	55.00	110.00	165.00																		60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	1	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												
S0522	024	0		29	10	S0522_024_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.83	55.00	110.00	165.00					1.66	50.00	100.00	150.00					1.66	50.00	100.00	150.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	1	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												
S0522	026	0		29	10	S0522_026_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	1	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												
S0522	026	0		29	10	S0522_026_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.83	55.00	110.00	165.00					1.66	50.00	100.00	150.00					1.66	50.00	100.00	150.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	1	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												
S0522	030	0		29	10	S0522_030_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	1	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												
S0522	032	0		29	10	S0522_032_0	1	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												
S0522	032	0		29	10	S0522_032_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.00	60.00	120.00	180.00					1.83	55.00	110.00	165.00					1.83	55.00	110.00	165.00																		60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	1	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												
S0522	034	0		29	10	S0522_034_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.16	65.00	130.00	195.00					2.00	60.00	120.00	180.00					2.00	60.00	120.00	180.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	1	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												
S0522	036	0		29	10	S0522_036_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.83	55.00	110.00	165.00					1.66	50.00	100.00	150.00					1.66	50.00	100.00	150.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	1	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												
S0522	037	0		29	10	S0522_037_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.83	55.00	110.00	165.00					1.66	50.00	100.00	150.00					1.66	50.00	100.00	150.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	1	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												
S0522	038	0		29	10	S0522_038_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.83	55.00	110.00	165.00					1.66	50.00	100.00	150.00					1.66	50.00	100.00	150.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.83	55.00	110.00	165.00					1.66	50.00	100.00	150.00					1.66	50.00	100.00	150.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	1	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												
S0522	040	0		29	10	S0522_040_0	1	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												
S0522	040	0		29	10	S0522_040_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.00	60.00	120.00	180.00					1.83	55.00	110.00	165.00					1.83	55.00	110.00	165.00																		60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	1	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												
S0522	042	0		29	10	S0522_042_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.16	65.00	130.00	195.00					2.00	60.00	120.00	180.00					2.00	60.00	120.00	180.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	1	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												
S0522	043	0		29	10	S0522_043_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.00	60.00	120.00	180.00					1.83	55.00	110.00	165.00					1.83	55.00	110.00	165.00																		60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	1	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												
S0522	043	0		29	10	S0522_043_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	1	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												
S0522	044	0		29	10	S0522_044_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.00	60.00	120.00	180.00					1.83	55.00	110.00	165.00					1.83	55.00	110.00	165.00																		60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	1	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												
S0522	045	0		29	10	S0522_045_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.83	55.00	110.00	165.00					1.66	50.00	100.00	150.00					1.66	50.00	100.00	150.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.16	65.00	130.00	195.00					2.00	60.00	120.00	180.00					2.00	60.00	120.00	180.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	1	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												
S0522	046	0		29	10	S0522_046_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.16	5.00	10.00	15.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	1	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.66	50.00	100.00	150.00					1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	1	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												
S0522	047	0		29	10	S0522_047_0	1	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					.83	25.00	50.00	75.00					.83	25.00	50.00	75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	1	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.06	2.00	4.00	6.00					.03	1.00	2.00	3.00					.03	1.00	2.00	3.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	048	0		29	10	S0522_048_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	048	0		29	10	S0522_048_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	049	0		29	10	S0522_049_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	049	0		29	10	S0522_049_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	050	0		29	10	S0522_050_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	051	0		29	10	S0522_051_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	051	0		29	10	S0522_051_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	052	0		29	10	S0522_052_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	052	0		29	10	S0522_052_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	053	0		29	10	S0522_053_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	053	0		29	10	S0522_053_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	054	0		29	10	S0522_054_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	054	0		29	10	S0522_054_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	054	0		29	10	S0522_054_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	055	0		29	10	S0522_055_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	055	0		29	10	S0522_055_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	056	0		29	10	S0522_056_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	056	0		29	10	S0522_056_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	057	0		29	10	S0522_057_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	057	0		29	10	S0522_057_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	058	0		29	10	S0522_058_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	058	0		29	10	S0522_058_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	059	0		29	10	S0522_059_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	060	0		29	10	S0522_060_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	060	0		29	10	S0522_060_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	061	0		29	10	S0522_061_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	061	0		29	10	S0522_061_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	062	0		29	10	S0522_062_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	062	0		29	10	S0522_062_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	063	0		29	10	S0522_063_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	063	0		29	10	S0522_063_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	063	0		29	10	S0522_063_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	064	0		29	10	S0522_064_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	064	0		29	10	S0522_064_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	065	0		29	10	S0522_065_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	065	0		29	10	S0522_065_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	066	0		29	10	S0522_066_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	066	0		29	10	S0522_066_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	067	0		29	10	S0522_067_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	068	0		29	10	S0522_068_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	068	0		29	10	S0522_068_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	068	0		29	10	S0522_068_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	069	0		29	10	S0522_069_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	070	0		29	10	S0522_070_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	070	0		29	10	S0522_070_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	071	0		29	10	S0522_071_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	071	0		29	10	S0522_071_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	072	0		29	10	S0522_072_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	072	0		29	10	S0522_072_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	073	0		29	10	S0522_073_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	073	0		29	10	S0522_073_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	074	0		29	10	S0522_074_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	074	0		29	10	S0522_074_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	075	0		29	10	S0522_075_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	075	0		29	10	S0522_075_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	076	0		29	10	S0522_076_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	076	0		29	10	S0522_076_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	077	0		29	10	S0522_077_0	1	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	1	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.50	75.00	150.00	225.00					2.33	70.00	140.00	210.00					2.33	70.00	140.00	210.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	1	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					1.00	30.00	60.00	90.00					1.00	30.00	60.00	90.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	1	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					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	1	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.13	4.00	8.00	12.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0522	077	0		29	10	S0522_077_0	1	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									.20	6.00	12.00	18.00					.13	4.00	8.00	12.00					.13	4.00	8.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0962	001	0		29	10	S0962_001_0	5	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					0.00	0.00		0.00															6.00							0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0962	001	0		29	10	S0962_001_0	5	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.03	1.00		3.00															10.00							2.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0962	001	0		29	10	S0962_001_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													312.00	25							312.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0962	001	0		29	10	S0962_001_0	5	4	Non-Preferred Brand	1	2	100000	1	2		110	01		100	1				30		90	1						90	30		31									3.16	95.00		285.00					2.96	89.00		267.00															190.00							178.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0962	001	0		29	10	S0962_001_0	5	3	Preferred Brand	1	2	000001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.30	39.00		117.00															90.00							78.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	1	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					2.50	75.00		150.00					2.50	75.00		150.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_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		135.00					1.33	40.00		80.00					1.33	40.00		80.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.43	13.00		39.00					.26	8.00		16.00					.26	8.00		16.00																		13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	1	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.23	7.00		21.00					0.06	2.00		4.00					.06	2.00		4.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	1	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	006	0		29	10	S1030_006_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.00	90.00		270.00					2.83	85.00		170.00					2.83	85.00		170.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	2	3	Preferred Brand	1	2	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		135.00					1.33	40.00		80.00					1.33	40.00		80.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	2	2	Non-Preferred Generic	1	2	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.46	14.00		42.00					.30	9.00		18.00					.30	9.00		18.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	2	1	Preferred Generic	1	2	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.26	8.00		24.00					.10	3.00		6.00					.10	3.00		6.00																		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	2	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												
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	0.33	10.00		30.00																					0.33	10.00		25.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	0.67	20.00		60.00																					0.67	20.00		50.00																			20.00			0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	1.47	44.00		132.00																					1.47	44.00		110.00																			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	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												
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												
S1140	002	0		29	10	S1140_002_0	1	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	0.17	5.00		15.00																					0.17	5.00		12.50																			5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1140	002	0		29	10	S1140_002_0	1	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.50	15.00		45.00																					0.50	15.00		37.50																			15.00			0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1140	002	0		29	10	S1140_002_0	1	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	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												
S1140	002	0		29	10	S1140_002_0	1	4	Non-Preferred Brand	1	4	100000	1	2	110		10	110		1	30		90				2	30		90					29	31	2.50	75.00		225.00																					2.50	75.00		187.50																			75.00			2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1140	002	0		29	10	S1140_002_0	1	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					34.00	33		33																					33		33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00								0.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31									0.30	9.00	18.00	27.00					0.16	5.00	10.00	10.00								10.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	3	Preferred Brand	1	2	010001	1	2		111	01	100		1				30	60	90	1			90				30		31									1.50	45.00	90.00	135.00					1.33	40.00	80.00	80.00								80.00																		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	2	4	Non-Preferred Brand	1	2	110000	1	2		111	01	100		1				30	60	90	1			90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	180.00								180.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	5	Injectable Drugs	1	2	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													178.00	25	25	25					178.00	25	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	2	6	Specialty Tier	1	2	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													900.00	25	25	25					900.00	25	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	3	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31									0.30	10.00	20.00	30.00					0.10	3.00	6.00	6.00								6.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31									0.63	19.00	38.00	57.00					0.30	9.00	18.00	18.00								18.00																		19.00				0.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31									1.50	45.00	90.00	135.00					1.33	40.00	80.00	80.00								80.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31									3.17	95.00	190.00	285.00					3.00	90.00	180.00	180.00								180.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													142.00	25	25	25					142.00	25	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	3	6	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31													1475.00	33	33	33					1475.00	33	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	4	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.23	37.00		111.00												1.50	45.00		135.00				1.23	37.00		92.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	001	0		29	10	S2505_001_0	4	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.90	87.00		261.00												3.16	95.00		285.00				2.90	87.00		217.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	001	0		29	10	S2505_001_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														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	4	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				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	4	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.06	2.00		6.00												.96	29.00		87.00				.06	2.00		5.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	4	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				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	4	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.83	25.00		75.00					.06	2.00		6.00												.83	25.00		75.00				.06	2.00		5.00				25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	4	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.16	35.00		105.00												1.50	45.00		135.00				1.16	35.00		87.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	4	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.80	84.00		252.00												3.16	95.00		285.00				2.80	84.00		210.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														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	4	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.93	88.00		264.00												3.16	95.00		285.00				2.93	88.00		220.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	005	0		29	10	S2505_005_0	4	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.23	37.00		111.00												1.50	45.00		135.00				1.23	37.00		92.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	005	0		29	10	S2505_005_0	4	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.10	3.00		9.00												.96	29.00		87.00				.10	3.00		7.50				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	005	0		29	10	S2505_005_0	4	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				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	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														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	4	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	4	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.16	5.00		15.00												.96	29.00		87.00				.16	5.00		12.50				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	4	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.26	38.00		114.00												1.50	45.00		135.00				1.26	38.00		95.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	4	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.90	87.00		261.00												3.16	95.00		285.00				2.90	87.00		217.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														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	4	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				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	4	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.06	2.00		6.00												.96	29.00		87.00				.06	2.00		5.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	009	0		29	10	S2505_009_0	4	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	4	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.93	88.00		264.00												3.16	95.00		285.00				2.93	88.00		220.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	009	0		29	10	S2505_009_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														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	4	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.93	88.00		264.00												3.16	95.00		285.00				2.93	88.00		220.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	010	0		29	10	S2505_010_0	4	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	010	0		29	10	S2505_010_0	4	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.16	5.00		15.00												.96	29.00		87.00				.16	5.00		12.50				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	010	0		29	10	S2505_010_0	4	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				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	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													69.00	50		50					62.00	45		45												50		50					45		45			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													59.00	50		50					39.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					17.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.30	9.00		27.00					0.06	2.00		6.00												0.30	9.00		27.00				0.06	2.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	2	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.20	6.00	12.00	18.00					0.03	1.00	2.00	3.00					0.03	1.00	1.00	1.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	2	5	Specialty Tier	1	3	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												
S2893	001	0		29	10	S2893_001_0	2	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													65.86	50	50	50					52.72	40	40	40					40	40	40																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	2	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.50	45.00	90.00	135.00					1.16	35.00	70.00	105.00					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												
S2893	001	0		29	10	S2893_001_0	2	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.53	16.00	32.00	48.00					0.20	6.00	12.00	18.00					0.20	6.00	12.00	12.00																		16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	2	1	Preferred Generic	3	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	4.00	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	2	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	2	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		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												
S2893	003	0		29	10	S2893_003_0	2	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.00	30.00	60.00	90.00																					1.00	30.00	60.00	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	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.30	9.00	18.00	27.00																					0.30	9.00	18.00	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	2	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.30	9.00	18.00	27.00																					0.30	9.00	18.00	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	2	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	4.00	4.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S3440	004	0		29	10	S3440_004_0	4	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.16	6.00	12.00	15.00																					.16	6.00	12.00	15.00																		6.00				.16	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S3440	004	0		29	10	S3440_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	.55	20.00	40.00	50.00																					.55	20.00	40.00	50.00																		20.00				.55	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S3440	004	0		29	10	S3440_004_0	4	5	Specialty Tier	1	3	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1081.49	30	30	30																					30	30	30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S3440	004	0		29	10	S3440_004_0	4	4	Non-Preferred Brand	1	3	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					93.56	30	30	30																					30	30	30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S3440	004	0		29	10	S3440_004_0	4	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.45	45.00	90.00	112.50																					1.45	45.00	90.00	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	001	0		29	10	S4054_001_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		7.50																								6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
S4054	001	0		29	10	S4054_001_0	2	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.30	9.00		22.50																								18.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
S4054	001	0		29	10	S4054_001_0	2	3	Preferred Brand	1	2	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												
S4054	001	0		29	10	S4054_001_0	2	4	Non-Preferred Brand	1	2	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.00	90.00		225.00																								180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
S4054	001	0		29	10	S4054_001_0	2	5	Specialty Tier	1	2	010010	1	1	110		01	100		1	30		90				1			90				30		31					200.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
S4054	001	0		29	10	S4054_001_0	2	6	Select Diabetic Drugs	1	2	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		25.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
S4054	002	0		29	10	S4054_002_0	1	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.30	9.00		22.50																								18.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
S4054	002	0		29	10	S4054_002_0	1	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				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
S4054	002	0		29	10	S4054_002_0	1	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												
S4054	002	0		29	10	S4054_002_0	1	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												
S4054	002	0		29	10	S4054_002_0	1	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.17	95.00		237.50																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
S4054	002	0		29	10	S4054_002_0	1	5	Specialty Tier	1	4	000010	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												
S4054	002	0		29	10	S4054_002_0	1	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.40	12.00		30.00																								24.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
S4054	002	0		29	10	S4054_002_0	1	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				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
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									.05	1.50		4.50					0.00	0.00		0.00					.05	1.50		4.50																		1.50				.05	1.50		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		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												
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		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												
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												
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									.57	17.00		51.00					.57	17.00		34.00					.57	17.00		51.00																		17.00				.55	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	4	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.93	88.00		264.00												3.16	95.00		285.00				2.93	88.00		220.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	4	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.23	37.00		111.00												1.50	45.00		135.00				1.23	37.00		92.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	4	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.13	4.00		12.00												.96	29.00		87.00				.13	4.00		10.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	4	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	4	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	4	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.20	6.00		18.00												.96	29.00		87.00				.20	6.00		15.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	4	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				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	4	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.20	36.00		108.00												1.50	45.00		135.00				1.20	36.00		90.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	4	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.20	6.00		18.00												.96	29.00		87.00				.20	6.00		15.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	4	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				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	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														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	4	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.86	86.00		258.00												3.16	95.00		285.00				2.86	86.00		215.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	4	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	4	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.90	87.00		261.00												3.16	95.00		285.00				2.90	87.00		217.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	4	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.16	35.00		105.00												1.50	45.00		135.00				1.16	35.00		87.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														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	4	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.83	25.00		75.00					.06	2.00		6.00												.83	25.00		75.00				.06	2.00		5.00				25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	4	4	Non-Preferred Brand	1	2	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		235.00				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	4	3	Preferred Brand	1	2	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.16	35.00		105.00												1.50	45.00		135.00				1.16	35.00		87.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	4	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.83	25.00		75.00					.06	2.00		6.00												.83	25.00		75.00				.06	2.00		5.00				25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	4	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														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	3	5	Specialty Tier	1	2	010010	1	1		111	01		111	1				30	60	90	2				30	60	90	30		31													1.00	25	25	25					1.00	25	25	25												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	3	4	Non-Preferred Brand	1	2	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00	190.00	285.00				2.83	85.00	170.00	212.50				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	3	3	Preferred Brand	1	2	000001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									1.50	45.00	90.00	135.00					1.33	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												
S5540	002	0		29	10	S5540_002_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									1.10	33.00	66.00	99.00					.33	10.00	20.00	30.00												1.10	33.00	66.00	99.00				.33	10.00	20.00	25.00				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	3	1	Preferred Generic	1	2	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									.33	10.00	20.00	30.00					.13	4.00	8.00	12.00												.33	10.00	20.00	30.00				.13	4.00	0.00	0.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	3	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												
S5540	004	0		29	10	S5540_004_0	3	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									3.16	95.00	190.00	285.00					2.33	70.00	140.00	210.00												3.16	95.00	190.00	285.00				2.33	70.00	140.00	175.00				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	3	3	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					1.00	30.00	60.00	90.00												1.50	45.00	90.00	135.00				1.00	30.00	60.00	75.00				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	3	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									.66	20.00	40.00	60.00					.20	6.00	12.00	18.00												.66	20.00	40.00	60.00				.20	6.00	12.00	15.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									.26	8.00	16.00	24.00					.10	3.00	6.00	9.00												.26	8.00	16.00	24.00				.10	3.00	0.00	0.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5540	004	0		29	10	S5540_004_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									.26	8.00	16.00	24.00					.10	3.00	6.00	9.00												.26	8.00	16.00	24.00				.10	3.00	0.00	0.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													82.00	50		50					68.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5552	004	0		29	10	S5552_004_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.03	1.00		3.00												0.06	2.00		6.00				0.03	1.00		0.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.06	2.00		6.00												0.10	3.00		9.00				0.06	2.00		0.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													70.00	36		36					61.00	35		35												36		36					35		35			36				36	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													28.00	25		25					21.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													75.00	50		50					46.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	25		25					18.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5569	006	0		29	10	S5569_006_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5569	006	0		29	10	S5569_006_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5569	006	0		29	10	S5569_006_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													58.77	50	50	50					54.07	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5569	006	0		29	10	S5569_006_0	2	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5569	008	0		29	10	S5569_008_0	3	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5569	008	0		29	10	S5569_008_0	3	3	Preferred Brand	3	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	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										2	1	
S5569	008	0		29	10	S5569_008_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5569	008	0		29	10	S5569_008_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													53.19	50	50	50					51.61	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5569	008	0		29	10	S5569_008_0	3	3	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	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												
S5569	008	0		29	10	S5569_008_0	3	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													83.72	50	50	50					81.82	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5569	008	0		29	10	S5569_008_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5569	008	0		29	10	S5569_008_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	003	0		29	10	S5580_003_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5580	003	0		29	10	S5580_003_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5580	003	0		29	10	S5580_003_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								30														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	003	0		29	10	S5580_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		113.00					1.23	37.00		93.00															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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													70.29	50							54.69	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	006	0		29	10	S5580_006_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															27.00							0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	006	0		29	10	S5580_006_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													33.56	31							30.31	26														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	006	0		29	10	S5580_006_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													18.94	21		21					14.45	16		16														21							21			21				21	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	006	0		29	10	S5580_006_0	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	007	0		29	10	S5580_007_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													59.48	50							46.79	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	007	0		29	10	S5580_007_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	007	0		29	10	S5580_007_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	007	0		29	10	S5580_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					1.00	30.00		90.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	007	0		29	10	S5580_007_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	7	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		237.50					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	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.51	16.00		48.00					.51	16.00		40.00					.51	16.00		40.00																		16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	7	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		112.50					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	7	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	7	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.12	4.00		12.00					.12	4.00		10.00					.12	4.00		10.00																		4.00				.12	4.00		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		15.00					.16	5.00		12.50					.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		6.00					.06	2.00		5.00					.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		6.00					.06	2.00		5.00					.06	2.00		5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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		135.00					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, 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									2.90	90.00		270.00					2.90	90.00		225.00					2.90	90.00		225.00																		90.00				2.90	90.00		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														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	6	5	Specialty Tier	1	2	010010	1	1	110		01	100		1	31		90				1			90				31		31					907.69	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	6	4	Non-Preferred Brand	1	2	100000	1	1	110		01	100		1	31		90				1			90				31		31					84.34	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	6	3	Preferred Brand	1	2	000001	1	1	110		01	100		1	31		90				1			90				31		31					56.11	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	6	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.38	12.00		36.00																								30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	6	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.06	2.00		6.00																								5.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	003	0		29	10	S5593_003_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												
S5593	003	0		29	10	S5593_003_0	5	2	Non-Preferred Generic	3	4	000100	1	1	110		01	100		1	31		90				1			90				31		31					26.71	45		45																							45																	45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5593	003	0		29	10	S5593_003_0	5	1	Preferred Generic	3	4	001000	1	1	110		01	100		1	31		90				1			90				31		31					9.93	45		45																							45																	45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5593	003	0		29	10	S5593_003_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1202.55	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.38	12.00		36.00																								30.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.12	4.00		12.00																								10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	001	0		29	10	S5596_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									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	5	5	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, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													73.56	40	40	40					69.89	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	5	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.50	45.00	90.00	135.00					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	003	0		29	10	S5596_003_0	5	5	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, Specialty Tier												
S5596	003	0		29	10	S5596_003_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													75.88	40	40	40					72.08	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	003	0		29	10	S5596_003_0	5	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.50	45.00	90.00	135.00					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	003	0		29	10	S5596_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									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	003	0		29	10	S5596_003_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	003	0		29	10	S5596_003_0	5	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	003	0		29	10	S5596_003_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	003	0		29	10	S5596_003_0	5	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.91	65	65	65					60.96	64	64	64					65	65	65																	65				65	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5596	005	0		29	10	S5596_005_0	6	5	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, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	6	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													67.57	35	35	35					63.71	33	33	33					33	33	33																	35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	6	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.30	39.00	78.00	117.00					1.13	34.00	68.00	102.00					1.13	34.00	102.00	102.00																		39.00				1.14	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	005	0		29	10	S5596_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									0.46	14.00	28.00	42.00					0.20	6.00	12.00	18.00					0.20	6.00	12.00	12.00																		14.00				0.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	6	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	7	5	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, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	7	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													77.17	40	40	40					73.31	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	006	0		29	10	S5596_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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	006	0		29	10	S5596_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									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	7	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	006	0		29	10	S5596_006_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	007	0		29	10	S5596_007_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	007	0		29	10	S5596_007_0	6	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.91	65	65	65					60.96	64	64	64					65	65	65																	65				65	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5596	007	0		29	10	S5596_007_0	6	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	007	0		29	10	S5596_007_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	007	0		29	10	S5596_007_0	6	5	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, Specialty Tier												
S5596	007	0		29	10	S5596_007_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	007	0		29	10	S5596_007_0	6	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	007	0		29	10	S5596_007_0	6	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													79.54	40	40	40					75.56	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	5	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	5	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													73.89	35	35	35					69.67	33	33	33					33	33	33																	35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	5	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					0.93	28.00	56.00	84.00					0.93	28.00	84.00	84.00																		33.00				0.97	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.46	14.00	28.00	42.00					0.20	6.00	12.00	18.00					0.20	6.00	12.00	12.00																		14.00				0.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	5	5	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, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	010	0		29	10	S5596_010_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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													76.18	40	40	40					72.37	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	5	5	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, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	011	0		29	10	S5596_011_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	011	0		29	10	S5596_011_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	011	0		29	10	S5596_011_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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	011	0		29	10	S5596_011_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													80.47	40	40	40					76.45	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	011	0		29	10	S5596_011_0	5	5	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, Specialty Tier												
S5596	011	0		29	10	S5596_011_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	011	0		29	10	S5596_011_0	5	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	011	0		29	10	S5596_011_0	5	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.91	65	65	65					60.96	64	64	64					65	65	65																	65				65	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5596	013	0		29	10	S5596_013_0	5	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.46	14.00	28.00	42.00					0.20	6.00	12.00	18.00					0.20	6.00	12.00	12.00																		14.00				0.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	5	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					1.16	35.00	70.00	105.00					1.16	35.00	105.00	105.00																		40.00				1.17	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	5	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													67.78	35	35	35					63.91	33	33	33					33	33	33																	35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	5	5	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, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	6	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	6	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													75.00	40	40	40					71.25	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	6	5	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, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	015	0		29	10	S5596_015_0	5	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.91	65	65	65					60.96	64	64	64					65	65	65																	65				65	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5596	015	0		29	10	S5596_015_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	015	0		29	10	S5596_015_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	015	0		29	10	S5596_015_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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	015	0		29	10	S5596_015_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													78.76	40	40	40					74.82	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	015	0		29	10	S5596_015_0	5	5	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, Specialty Tier												
S5596	015	0		29	10	S5596_015_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	015	0		29	10	S5596_015_0	5	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	017	0		29	10	S5596_017_0	5	5	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, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	5	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													65.65	35	35	35					61.90	33	33	33					33	33	33																	35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	5	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					0.96	29.00	58.00	87.00					0.96	29.00	87.00	87.00																		34.00				1.00	34.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.46	14.00	28.00	42.00					0.20	6.00	12.00	18.00					0.20	6.00	12.00	12.00																		14.00				0.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	5	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	018	0		29	10	S5596_018_0	6	5	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, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	6	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													70.71	40	40	40					67.18	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	6	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	019	0		29	10	S5596_019_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													70.49	40	40	40					66.96	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	019	0		29	10	S5596_019_0	5	5	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, Specialty Tier												
S5596	019	0		29	10	S5596_019_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	019	0		29	10	S5596_019_0	5	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	019	0		29	10	S5596_019_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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	019	0		29	10	S5596_019_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	019	0		29	10	S5596_019_0	5	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.91	65	65	65					60.96	64	64	64					65	65	65																	65				65	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5596	019	0		29	10	S5596_019_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	5	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													79.41	35	35	35					74.87	33	33	33					33	33	33																	35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	5	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					1.10	33.00	66.00	99.00					1.10	33.00	99.00	99.00																		38.00				1.11	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.46	14.00	28.00	42.00					0.20	6.00	12.00	18.00					0.20	6.00	12.00	12.00																		14.00				0.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	5	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	5	5	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, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	6	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													82.50	40	40	40					78.37	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	6	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	6	5	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, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	035	0		29	10	S5596_035_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	035	0		29	10	S5596_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									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	035	0		29	10	S5596_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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	035	0		29	10	S5596_035_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													84.70	40	40	40					80.46	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	035	0		29	10	S5596_035_0	5	5	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, Specialty Tier												
S5596	035	0		29	10	S5596_035_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	035	0		29	10	S5596_035_0	5	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	035	0		29	10	S5596_035_0	5	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.91	65	65	65					60.96	64	64	64					65	65	65																	65				65	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5596	043	0		29	10	S5596_043_0	5	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.43	13.00	26.00	39.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		13.00				0.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	5	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.06	32.00	64.00	96.00					.90	27.00	54.00	81.00					0.90	27.00	81.00	81.00																		32.00				0.94	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	5	5	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, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	5	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													67.81	35	35	35					63.93	33	33	33					33	33	33																	35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	044	0		29	10	S5596_044_0	6	5	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, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	6	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													75.71	40	40	40					71.92	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	6	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	045	0		29	10	S5596_045_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	045	0		29	10	S5596_045_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	045	0		29	10	S5596_045_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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	045	0		29	10	S5596_045_0	5	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.91	65	65	65					60.96	64	64	64					65	65	65																	65				65	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5596	045	0		29	10	S5596_045_0	5	5	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, Specialty Tier												
S5596	045	0		29	10	S5596_045_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	045	0		29	10	S5596_045_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													74.22	40	40	40					70.51	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	045	0		29	10	S5596_045_0	5	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	046	0		29	10	S5596_046_0	5	5	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, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	5	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													71.11	35	35	35					67.05	33	33	33					33	33	33																	35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.46	14.00	28.00	42.00					0.20	6.00	12.00	18.00					0.20	6.00	12.00	12.00																		14.00				0.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	5	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	5	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.40	42.00	84.00	126.00					1.23	37.00	74.00	111.00					1.23	37.00	111.00	111.00																		42.00				1.23	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	5	5	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, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	5	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													70.42	35	35	35					66.39	33	33	33					33	33	33																	35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	5	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.06	32.00	64.00	96.00					0.90	27.00	54.00	81.00					0.90	27.00	81.00	81.00																		32.00				0.94	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.40	12.00	24.00	36.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	5	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					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		8.00				.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	057	0		29	10	S5596_057_0	6	5	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, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	6	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													69.35	40	40	40					65.88	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	6	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	058	0		29	10	S5596_058_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	058	0		29	10	S5596_058_0	5	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.91	65	65	65					60.96	64	64	64					65	65	65																	65				65	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5596	058	0		29	10	S5596_058_0	5	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	058	0		29	10	S5596_058_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	058	0		29	10	S5596_058_0	5	5	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, Specialty Tier												
S5596	058	0		29	10	S5596_058_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	058	0		29	10	S5596_058_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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	058	0		29	10	S5596_058_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													71.28	40	40	40					67.72	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	6	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	6	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													76.10	35	35	35					71.75	33	33	33					33	33	33																	35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	6	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					1.00	30.00	60.00	90.00					1.00	30.00	90.00	90.00																		35.00				1.02	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.46	14.00	28.00	42.00					0.20	6.00	12.00	18.00					0.20	6.00	12.00	12.00																		14.00				0.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	6	5	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, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	060	0		29	10	S5596_060_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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													89.36	40	40	40					84.89	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	5	5	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, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	060	0		29	10	S5596_060_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	061	0		29	10	S5596_061_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	061	0		29	10	S5596_061_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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	061	0		29	10	S5596_061_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													83.59	40	40	40					79.41	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	061	0		29	10	S5596_061_0	5	5	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, Specialty Tier												
S5596	061	0		29	10	S5596_061_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	061	0		29	10	S5596_061_0	5	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	061	0		29	10	S5596_061_0	5	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.91	65	65	65					60.96	64	64	64					65	65	65																	65				65	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5596	061	0		29	10	S5596_061_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	5	5	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, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	5	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													79.48	35	35	35					74.94	33	33	33					33	33	33																	35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	5	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					1.00	30.00	60.00	90.00					1.00	30.00	90.00	90.00																		35.00				1.02	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.43	13.00	26.00	39.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		13.00				0.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	5	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	6	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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	6	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													71.59	40	40	40					68.01	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	6	5	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, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	064	0		29	10	S5596_064_0	5	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.91	65	65	65					60.96	64	64	64					65	65	65																	65				65	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5596	064	0		29	10	S5596_064_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	064	0		29	10	S5596_064_0	5	5	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, Specialty Tier												
S5596	064	0		29	10	S5596_064_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													93.37	40	40	40					88.71	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	064	0		29	10	S5596_064_0	5	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	064	0		29	10	S5596_064_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	064	0		29	10	S5596_064_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	064	0		29	10	S5596_064_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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	5	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	5	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					51.43	43	43	43																					43	43	43																	43				43	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	5	2	Preferred Brand	1	3	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	1.27	38.00	76.00	95.00																					1.27	38.00	76.00	95.00																		38.00				1.12	38.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	5	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					591.36	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	003	0		29	10	S5601_003_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	003	0		29	10	S5601_003_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													56.88	50	50	50					45.50	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													482.44	33							482.44	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	004	0		29	10	S5601_004_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					587.36	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					56.35	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	3	2	Preferred Brand	1	3	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.90	27.00	54.00	67.50																					0.90	27.00	54.00	67.50																		27.00				0.79	27.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		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	1		111	01		111	1				30	60	90	2				30	60	90	30		34													59.01	50	50	50					47.21	40	40	40												50	50	50					40	40	40			50				50	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									0.23	7.00	14.00	21.00					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												
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									1.03	31.00	62.00	93.00					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	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									0.23	7.00	14.00	21.00					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	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													599.91	33							599.91	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	3	2	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	85.00																					1.13	34.00	68.00	85.00																		34.00				1.00	34.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					58.79	47	47	47																					47	47	47																	47				47	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					567.51	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													594.21	33							594.21	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													59.57	50	50	50					47.66	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	007	0		29	10	S5601_007_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	008	0		29	10	S5601_008_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					574.10	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	3	2	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	85.00																					1.13	34.00	68.00	85.00																		34.00				1.00	34.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					61.62	47	47	47																					47	47	47																	47				47	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	009	0		29	10	S5601_009_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	009	0		29	10	S5601_009_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													65.88	50	50	50					52.70	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													639.28	33							639.28	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					551.07	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					55.35	46	46	46																					46	46	46																	46				46	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	3	2	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	100.00																					1.33	40.00	80.00	100.00																		40.00				1.18	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													538.50	33							538.50	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													55.53	50	50	50					44.42	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	011	0		29	10	S5601_011_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	012	0		29	10	S5601_012_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	3	2	Preferred Brand	1	3	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	1.07	32.00	64.00	80.00																					1.07	32.00	64.00	80.00																		32.00				0.94	32.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					602.11	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					56.64	47	47	47																					47	47	47																	47				47	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	013	0		29	10	S5601_013_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	013	0		29	10	S5601_013_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													56.11	50	50	50					44.89	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													636.42	33							636.42	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	014	0		29	10	S5601_014_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					49.77	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	3	2	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	90.00																					1.20	36.00	72.00	90.00																		36.00				1.06	36.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					583.77	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	015	0		29	10	S5601_015_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													602.56	33							602.56	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													52.89	50	50	50					42.31	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	016	0		29	10	S5601_016_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	3	2	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	92.50																					1.23	37.00	74.00	92.50																		37.00				1.09	37.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					588.83	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					54.98	47	47	47																					47	47	47																	47				47	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													50.72	50	50	50					40.57	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													563.59	33							563.59	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	017	0		29	10	S5601_017_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	018	0		29	10	S5601_018_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					51.02	46	46	46																					46	46	46																	46				46	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	3	2	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	85.00																					1.13	34.00	68.00	85.00																		34.00				1.00	34.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					606.82	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	019	0		29	10	S5601_019_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	019	0		29	10	S5601_019_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													548.65	33							548.65	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													49.39	50	50	50					39.51	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	020	0		29	10	S5601_020_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					556.31	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					49.00	46	46	46																					46	46	46																	46				46	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	3	2	Preferred Brand	1	3	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	1.17	35.00	70.00	87.50																					1.17	35.00	70.00	87.50																		35.00				1.03	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													667.33	33							667.33	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													51.16	50	50	50					40.93	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	021	0		29	10	S5601_021_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	022	0		29	10	S5601_022_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	3	2	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	100.00																					1.33	40.00	80.00	100.00																		40.00				1.18	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					580.09	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					53.88	42	42	42																					42	42	42																	42				42	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	023	0		29	10	S5601_023_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	023	0		29	10	S5601_023_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													58.04	50	50	50					46.43	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													659.21	33							659.21	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	024	0		29	10	S5601_024_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					48.88	47	47	47																					47	47	47																	47				47	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	3	2	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	82.50																					1.10	33.00	66.00	82.50																		33.00				0.97	33.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					631.64	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	025	0		29	10	S5601_025_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													640.30	33							640.30	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													49.48	50	50	50					39.58	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	026	0		29	10	S5601_026_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					655.34	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					54.63	43	43	43																					43	43	43																	43				43	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	3	2	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	100.00																					1.33	40.00	80.00	100.00																		40.00				1.18	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													614.70	33							614.70	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													57.42	50	50	50					45.93	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	027	0		29	10	S5601_027_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	027	0		29	10	S5601_027_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	028	0		29	10	S5601_028_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					611.55	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					55.43	46	46	46																					46	46	46																	46				46	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	3	2	Preferred Brand	1	3	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.90	27.00	54.00	67.50																					0.90	27.00	54.00	67.50																		27.00				0.79	27.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	029	0		29	10	S5601_029_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	029	0		29	10	S5601_029_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													55.27	50	50	50					44.21	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	029	0		29	10	S5601_029_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													561.40	33							561.40	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					596.33	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					52.25	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	3	2	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	85.00																					1.13	34.00	68.00	85.00																		34.00				1.00	34.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	031	0		29	10	S5601_031_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													53.92	50	50	50					43.14	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													622.63	33							622.63	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	032	0		29	10	S5601_032_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					616.80	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					53.59	43	43	43																					43	43	43																	43				43	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	3	2	Preferred Brand	1	3	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.87	26.00	52.00	65.00																					0.87	26.00	52.00	65.00																		26.00				0.76	26.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													514.18	33							514.18	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													59.36	50	50	50					47.49	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	033	0		29	10	S5601_033_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	034	0		29	10	S5601_034_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					590.77	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					51.48	43	43	43																					43	43	43																	43				43	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	3	2	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	92.50																					1.23	37.00	74.00	92.50																		37.00				1.09	37.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													582.81	33							582.81	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													58.74	50	50	50					46.99	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	035	0		29	10	S5601_035_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	036	0		29	10	S5601_036_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					622.08	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					53.06	43	43	43																					43	43	43																	43				43	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	3	2	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	77.50																					1.03	31.00	62.00	77.50																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	037	0		29	10	S5601_037_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													56.57	50	50	50					45.26	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													572.31	33							572.31	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	038	0		29	10	S5601_038_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					46.15	44	44	44																					44	44	44																	44				44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	3	2	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	82.50																					1.10	33.00	66.00	82.50																		33.00				0.97	33.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					599.23	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					627.09	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					50.12	47	47	47																					47	47	47																	47				47	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	3	2	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	92.50																					1.23	37.00	74.00	92.50																		37.00				1.09	37.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	041	0		29	10	S5601_041_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	041	0		29	10	S5601_041_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													50.16	50	50	50					40.13	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													657.53	33							657.53	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	042	0		29	10	S5601_042_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					558.07	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					51.66	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	3	2	Preferred Brand	1	3	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.97	29.00	58.00	72.50																					0.97	29.00	58.00	72.50																		29.00				0.85	29.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					56.61	47	47	47																					47	47	47																	47				47	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	3	2	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	92.50																					1.23	37.00	74.00	92.50																		37.00				1.09	37.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					586.54	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	045	0		29	10	S5601_045_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													602.25	33							602.25	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													59.21	50	50	50					47.37	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	046	0		29	10	S5601_046_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					53.34	46	46	46																					46	46	46																	46				46	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					633.88	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	3	2	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	82.50																					1.10	33.00	66.00	82.50																		33.00				0.97	33.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	3	2	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	90.00																					1.20	36.00	72.00	90.00																		36.00				1.06	36.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					48.34	42	42	42																					42	42	42																	42				42	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					659.26	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													55.77	50	50	50					44.62	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	049	0		29	10	S5601_049_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	049	0		29	10	S5601_049_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													712.44	33							712.44	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	050	0		29	10	S5601_050_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					607.34	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					52.05	43	43	43																					43	43	43																	43				43	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	3	2	Preferred Brand	1	3	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.73	22.00	44.00	55.00																					0.73	22.00	44.00	55.00																		22.00				0.65	22.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.30	9.00	18.00	22.50																					0.30	9.00	18.00	22.50																		9.00				0.26	9.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													626.92	33							626.92	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													54.91	50	50	50					43.93	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	051	0		29	10	S5601_051_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	052	0		29	10	S5601_052_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	3	2	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	100.00																					1.33	40.00	80.00	100.00																		40.00				1.18	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					658.22	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					48.35	44	44	44																					44	44	44																	44				44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	053	0		29	10	S5601_053_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	053	0		29	10	S5601_053_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													53.99	50	50	50					43.20	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													948.23	33							948.23	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	054	0		29	10	S5601_054_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					53.24	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	3	2	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	100.00																					1.33	40.00	80.00	100.00																		40.00				1.18	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					642.86	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	055	0		29	10	S5601_055_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													786.19	33							786.19	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													56.19	50	50	50					44.96	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	056	0		29	10	S5601_056_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					624.84	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					49.94	46	46	46																					46	46	46																	46				46	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	3	2	Preferred Brand	1	3	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	1.17	35.00	70.00	87.50																					1.17	35.00	70.00	87.50																		35.00				1.03	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.30	9.00	18.00	22.50																					0.30	9.00	18.00	22.50																		9.00				0.26	9.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													596.28	33							596.28	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													59.37	50	50	50					47.50	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	057	0		29	10	S5601_057_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	057	0		29	10	S5601_057_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	058	0		29	10	S5601_058_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					641.65	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					53.46	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	3	2	Preferred Brand	1	3	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	1.17	35.00	70.00	87.50																					1.17	35.00	70.00	87.50																		35.00				1.03	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	059	0		29	10	S5601_059_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	059	0		29	10	S5601_059_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													55.04	50	50	50					44.03	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													769.79	33							769.79	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					49.01	43	43	43																					43	43	43																	43				43	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					609.32	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	3	2	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	92.50																					1.23	37.00	74.00	92.50																		37.00				1.09	37.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	061	0		29	10	S5601_061_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	061	0		29	10	S5601_061_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													53.02	50	50	50					42.42	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													530.96	33							530.96	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	062	0		29	10	S5601_062_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	3	2	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	82.50																					1.10	33.00	66.00	82.50																		33.00				0.97	33.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					49.58	42	42	42																					42	42	42																	42				42	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					630.35	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	063	0		29	10	S5601_063_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													589.73	33							589.73	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													49.93	50	50	50					39.95	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	064	0		29	10	S5601_064_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					596.28	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					55.14	43	43	43																					43	43	43																	43				43	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	3	2	Preferred Brand	1	3	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	1.37	41.00	82.00	102.50																					1.37	41.00	82.00	102.50																		41.00				1.21	41.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.27	8.00	16.00	20.00																					0.27	8.00	16.00	20.00																		8.00				0.24	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	065	0		29	10	S5601_065_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													61.71	50	50	50					49.37	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													609.91	33							609.91	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	066	0		29	10	S5601_066_0	3	2	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	90.00																					1.20	36.00	72.00	90.00																		36.00				1.06	36.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	3	1	Generic	1	3	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.33	10.00	20.00	25.00																					0.33	10.00	20.00	25.00																		10.00				0.29	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	3	3	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					70.89	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	3	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34					603.12	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	067	0		29	10	S5601_067_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	067	0		29	10	S5601_067_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													52.06	50	50	50					41.65	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													743.23	33							743.23	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	068	0		29	10	S5601_068_0	4	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.07	2.00	4.00	5.00																					0.07	2.00	4.00	5.00																		2.00				0.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	4	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					12.43	17	17	17																					17	17	17																	17				17	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	4	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					37.37	37	37	37																					37	37	37																	37				37	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	4	4	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		34					389.92	25																							25																			25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	107	0		29	10	S5601_107_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	107	0		29	10	S5601_107_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													50.99	50	50	50					40.79	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													720.40	33							720.40	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	108	0		29	10	S5601_108_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	108	0		29	10	S5601_108_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													52.09	50	50	50					41.67	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													607.21	33							607.21	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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	3	1	Generic	1	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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												
S5601	109	0		29	10	S5601_109_0	3	2	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.03	31.00	62.00	93.00					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	109	0		29	10	S5601_109_0	3	4	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													589.29	33							589.29	33														33							33					33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34													53.30	50	50	50					42.64	40	40	40												50	50	50					40	40	40			50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	3	1	Generic	3	4	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.23	7.00	14.00	21.00					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		
S5609	001	0		29	10	S5609_001_0	5	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					1113.00	27																							27																			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	5	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	5	3	Preferred Brand	1	3	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												
S5609	001	0		29	10	S5609_001_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.50	15.00		30.00																					0.50	15.00		30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	5	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.23	7.00		14.00																					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					1360.00	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	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		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	1.50	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												
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	0.40	12.00		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	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										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	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												
S5617	003	0		29	10	S5617_003_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.13	4.00	8.00	12.00												0.36	11.00		33.00				0.13	4.00		12.00				11.00				0.35	11.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	24	24	24					38.17	20	20	20												24		24					20		20			24				24	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	1		111	01		110	1				30	60	90	2				30		90	30		31													95.00	40	40	40					83.94	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													205.71	25	25	25					204.14	25	25	25												25		25					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	4	2	Non-Preferred Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.13	4.00	8.00	12.00												0.36	11.00		33.00				0.13	4.00		12.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	4	3	Preferred Brand	1	2	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	24	24	24					39.18	20	20	20												24		24					20		20			24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													95.00	40	40	40					84.78	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													227.96	25	25	25					224.45	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	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.16	5.00	10.00	15.00					0.03	1.00	2.00	3.00												0.16	5.00		15.00				0.03	1.00		3.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	4	2	Non-Preferred Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.13	4.00	8.00	12.00												0.36	11.00		33.00				0.13	4.00		12.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	4	3	Preferred Brand	1	2	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	24	24	24					38.28	20	20	20												24		24					20		20			24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													88.96	40	40	40					77.27	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													239.22	25	25	25					237.38	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	4	3	Preferred Brand	1	2	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	24	24	24					38.46	20	20	20												24		24					20		20			24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	4	2	Non-Preferred Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.13	4.00	8.00	12.00												0.36	11.00		33.00				0.13	4.00		12.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													239.40	25	25	25					236.88	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	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													94.52	40	40	40					81.91	35	35	35												40		40					35		35			40				40	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	1		111	01		110	1				30	60	90	2				30		90	30		31													95.00	38	38	38					90.79	35	35	35												38		38					35		35			38				38	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.40	12.00	24.00	36.00					0.16	5.00	10.00	15.00												0.40	12.00		36.00				0.16	5.00		15.00				12.00				0.38	12.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.16	5.00	10.00	15.00					0.03	1.00	2.00	3.00												0.16	5.00		15.00				0.03	1.00		3.00				5.00				0.16	5.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					39.54	20	20	20												23		23					20		20			23				23	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		111	01		110	1				30	60	90	2				30		90	30		31													229.16	25	25	25					227.13	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	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.13	4.00	8.00	12.00												0.36	11.00		33.00				0.13	4.00		12.00				11.00				0.35	11.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					40.31	20	20	20												23		23					20		20			23				23	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	1		111	01		110	1				30	60	90	2				30		90	30		31													94.65	38	38	38					86.98	35	35	35												38		38					35		35			38				38	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		111	01		110	1				30	60	90	2				30		90	30		31													228.36	25	25	25					226.44	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	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.10	3.00	6.00	9.00												0.36	11.00		33.00				0.10	3.00		9.00				11.00				0.35	11.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					39.98	20	20	20												23		23					20		20			23				23	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	1		111	01		110	1				30	60	90	2				30		90	30		31													95.00	40	40	40					83.19	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													231.44	25	25	25					229.14	25	25	25												25		25					25		25			25				25	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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.16	5.00	10.00	15.00					0.03	1.00	2.00	3.00												0.16	5.00		15.00				0.03	1.00		3.00				5.00				0.16	5.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.13	4.00	8.00	12.00												0.36	11.00		33.00				0.13	4.00		12.00				11.00				0.35	11.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	22	22	22					40.46	20	20	20												22		22					20		20			22				22	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	1		111	01		110	1				30	60	90	2				30		90	30		31													89.63	40	40	40					77.80	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													242.31	25	25	25					239.79	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	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.16	5.00	10.00	15.00					0.03	1.00	2.00	3.00												0.16	5.00		15.00				0.03	1.00		3.00				5.00				0.16	5.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.40	12.00	24.00	36.00					0.13	4.00	8.00	12.00												0.40	12.00		36.00				0.13	4.00		12.00				12.00				0.38	12.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					39.88	20	20	20												23		23					20		20			23				23	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	1		111	01		110	1				30	60	90	2				30		90	30		31													91.61	40	40	40					79.19	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													236.82	25	25	25					235.49	25	25	25												25		25					25		25			25				25	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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.10	3.00	6.00	9.00												0.33	10.00		30.00				0.10	3.00		9.00				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	3	Preferred Brand	1	2	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					39.76	20	20	20												23		23					20		20			23				23	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	1		111	01		110	1				30	60	90	2				30		90	30		31													87.06	40	40	40					75.26	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													226.91	25	25	25					224.96	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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.13	4.00	8.00	12.00												0.36	11.00		33.00				0.13	4.00		12.00				11.00				0.35	11.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	24	24	24					38.79	20	20	20												24		24					20		20			24				24	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	1		111	01		110	1				30	60	90	2				30		90	30		31													92.60	40	40	40					80.60	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													213.98	25	25	25					213.11	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	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					39.06	20	20	20												23		23					20		20			23				23	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		111	01		110	1				30	60	90	2				30		90	30		31													221.49	25	25	25					218.70	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	1		111	01		110	1				30	60	90	2				30		90	30		31													93.02	40	40	40					80.82	35	35	35												40		40					35		35			40				40	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.10	3.00	6.00	9.00												0.36	11.00		33.00				0.10	3.00		9.00				11.00				0.35	11.00		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		111	01		110	1				30	60	90	2				30		90	30		31													228.32	25	25	25					223.94	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	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													86.20	45	45	45					75.79	40	40	40												45		45					40		40			45				45	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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													42.76	23	23	23					36.80	20	20	20												23		23					20		20			23				23	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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.16	5.00	10.00	15.00					0.03	1.00	2.00	3.00												0.16	5.00		15.00				0.03	1.00		3.00				5.00				0.16	5.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.43	13.00	26.00	39.00					0.16	5.00	10.00	15.00												0.43	13.00		39.00				0.16	5.00		15.00				13.00				0.41	13.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.20	6.00	12.00	18.00					0.03	1.00	2.00	3.00												0.20	6.00		18.00				0.03	1.00		3.00				6.00				0.19	6.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.50	15.00	30.00	45.00					0.23	7.00	14.00	21.00												0.50	15.00		45.00				0.23	7.00		21.00				15.00				0.48	15.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					39.45	20	20	20												23		23					20		20			23				23	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	1		111	01		110	1				30	60	90	2				30		90	30		31													95.00	38	38	38					89.64	35	35	35												38		38					35		35			38				38	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		111	01		110	1				30	60	90	2				30		90	30		31													221.51	25	25	25					223.11	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	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.16	5.00	10.00	15.00					0.03	1.00	2.00	3.00												0.16	5.00		15.00				0.03	1.00		3.00				5.00				0.16	5.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.46	14.00	28.00	42.00					0.20	6.00	12.00	18.00												0.46	14.00		42.00				0.20	6.00		18.00				14.00				0.45	14.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					39.64	20	20	20												23		23					20		20			23				23	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	1		111	01		110	1				30	60	90	2				30		90	30		31													89.22	40	40	40					77.77	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													268.59	25	25	25					267.18	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	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.43	13.00	26.00	39.00					0.16	5.00	10.00	15.00												0.43	13.00		39.00				0.16	5.00		15.00				13.00				0.41	13.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					39.78	20	20	20												23		23					20		20			23				23	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	1		111	01		110	1				30	60	90	2				30		90	30		31													83.38	40	40	40					71.90	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													244.76	25	25	25					241.25	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	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.40	12.00	24.00	36.00					0.13	4.00	8.00	12.00												0.40	12.00		36.00				0.13	4.00		12.00				12.00				0.38	12.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	24	24	24					38.20	20	20	20												24		24					20		20			24				24	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	1		111	01		110	1				30	60	90	2				30		90	30		31													95.00	40	40	40					82.85	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													242.01	25	25	25					240.20	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	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													229.88	25	25	25					228.86	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	1		111	01		110	1				30	60	90	2				30		90	30		31													95.00	40	40	40					82.50	35	35	35												40		40					35		35			40				40	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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					40.16	20	20	20												23		23					20		20			23				23	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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.16	5.00	10.00	15.00					0.03	1.00	2.00	3.00												0.16	5.00		15.00				0.03	1.00		3.00				5.00				0.16	5.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.40	12.00	24.00	36.00					0.16	5.00	10.00	15.00												0.40	12.00		36.00				0.16	5.00		15.00				12.00				0.38	12.00		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		111	01		110	1				30	60	90	2				30		90	30		31													265.66	25	25	25					262.74	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	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													91.83	40	40	40					79.50	35	35	35												40		40					35		35			40				40	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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	24	24	24					38.94	20	20	20												24		24					20		20			24				24	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.13	4.00	8.00	12.00												0.36	11.00		33.00				0.13	4.00		12.00				11.00				0.35	11.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.46	14.00	28.00	42.00					0.20	6.00	12.00	18.00												0.46	14.00		42.00				0.20	6.00		18.00				14.00				0.45	14.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	22	22	22					43.41	20	20	20												22		22					20		20			22				22	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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.20	6.00	12.00	18.00					0.06	2.00	4.00	6.00												0.20	6.00		18.00				0.06	2.00		6.00				6.00				0.19	6.00		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		111	01		110	1				30	60	90	2				30		90	30		31													241.74	25	25	25					239.58	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	1		111	01		110	1				30	60	90	2				30		90	30		31													90.66	35	35	35					76.28	30	30	30												35		35					30		30			35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	172	0		29	10	S5617_172_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	172	0		29	10	S5617_172_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	172	0		29	10	S5617_172_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	172	0		29	10	S5617_172_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	172	0		29	10	S5617_172_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	172	0		29	10	S5617_172_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													355.76	33	33	33					344.23	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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	172	0		29	10	S5617_172_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	176	0		29	10	S5617_176_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	176	0		29	10	S5617_176_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	176	0		29	10	S5617_176_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	176	0		29	10	S5617_176_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													336.36	33	33	33					332.39	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		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	177	0		29	10	S5617_177_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													400.54	33	33	33					402.26	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	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	177	0		29	10	S5617_177_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	177	0		29	10	S5617_177_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	178	0		29	10	S5617_178_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	178	0		29	10	S5617_178_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	178	0		29	10	S5617_178_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	178	0		29	10	S5617_178_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	178	0		29	10	S5617_178_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	178	0		29	10	S5617_178_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	178	0		29	10	S5617_178_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													338.84	33	33	33					342.50	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	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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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		111	01		110	1				30	60	90	2				30		90	30		31													348.48	33	33	33					352.63	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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	179	0		29	10	S5617_179_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	179	0		29	10	S5617_179_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	181	0		29	10	S5617_181_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	181	0		29	10	S5617_181_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	181	0		29	10	S5617_181_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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.88	33	33	33					354.66	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	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	181	0		29	10	S5617_181_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	182	0		29	10	S5617_182_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	182	0		29	10	S5617_182_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	182	0		29	10	S5617_182_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	182	0		29	10	S5617_182_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	182	0		29	10	S5617_182_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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	182	0		29	10	S5617_182_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													345.00	33	33	33					339.79	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	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	183	0		29	10	S5617_183_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	183	0		29	10	S5617_183_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	183	0		29	10	S5617_183_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	183	0		29	10	S5617_183_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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	183	0		29	10	S5617_183_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													308.16	33	33	33					299.75	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	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	184	0		29	10	S5617_184_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	184	0		29	10	S5617_184_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	184	0		29	10	S5617_184_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	184	0		29	10	S5617_184_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													336.45	33	33	33					341.55	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	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	185	0		29	10	S5617_185_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	185	0		29	10	S5617_185_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	185	0		29	10	S5617_185_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.68	33	33	33					349.64	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	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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	185	0		29	10	S5617_185_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	187	0		29	10	S5617_187_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	187	0		29	10	S5617_187_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	187	0		29	10	S5617_187_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	187	0		29	10	S5617_187_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	187	0		29	10	S5617_187_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	187	0		29	10	S5617_187_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													362.11	33	33	33					372.24	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	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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	188	0		29	10	S5617_188_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	188	0		29	10	S5617_188_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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		111	01		110	1				30	60	90	2				30		90	30		31													430.61	33	33	33					476.26	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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	189	0		29	10	S5617_189_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	189	0		29	10	S5617_189_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	189	0		29	10	S5617_189_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	189	0		29	10	S5617_189_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	189	0		29	10	S5617_189_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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													229.83	33	33	33					217.30	33	33	33												33		33					33		33			33				33	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		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	192	0		29	10	S5617_192_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													397.40	33	33	33					397.45	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		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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		111	01		110	1				30	60	90	2				30		90	30		31													308.90	33	33	33					313.05	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		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	195	0		29	10	S5617_195_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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		111	01		110	1				30	60	90	2				30		90	30		31													347.34	33	33	33					353.80	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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	214	0		29	10	S5617_214_0	3	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													95.00	40	40	40					83.70	35	35	35												40		40					35		35			40				40	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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	24	24	24					39.34	20	20	20												24		24					20		20			24				24	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.13	4.00	8.00	12.00												0.36	11.00		33.00				0.13	4.00		12.00				11.00				0.35	11.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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		111	01		110	1				30	60	90	2				30		90	30		31													253.06	25	25	25					251.81	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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.16	5.00	10.00	15.00					0.03	1.00	2.00	3.00												0.16	5.00		15.00				0.03	1.00		3.00				5.00				0.16	5.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	Preferred Brand	1	2	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					39.54	20	20	20												23		23					20		20			23				23	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	1		111	01		110	1				30	60	90	2				30		90	30		31													91.77	40	40	40					79.84	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													230.49	25	25	25					228.34	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	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													228.94	25	25	25					228.68	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	1		111	01		110	1				30	60	90	2				30		90	30		31													85.92	40	40	40					74.91	35	35	35												40		40					35		35			40				40	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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	24	24	24					38.97	20	20	20												24		24					20		20			24				24	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.10	3.00	6.00	9.00												0.36	11.00		33.00				0.10	3.00		9.00				11.00				0.35	11.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.16	5.00	10.00	15.00					0.03	1.00	2.00	3.00												0.16	5.00		15.00				0.03	1.00		3.00				5.00				0.16	5.00		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		111	01		110	1				30	60	90	2				30		90	30		31													234.56	25	25	25					232.57	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	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													88.96	40	40	40					77.46	35	35	35												40		40					35		35			40				40	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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					40.15	20	20	20												23		23					20		20			23				23	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.10	3.00	6.00	9.00												0.33	10.00		30.00				0.10	3.00		9.00				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	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					40.36	20	20	20												23		23					20		20			23				23	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		111	01		110	1				30	60	90	2				30		90	30		31													252.52	25	25	25					252.12	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	1		111	01		110	1				30	60	90	2				30		90	30		31													92.10	40	40	40					79.96	35	35	35												40		40					35		35			40				40	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.13	4.00	8.00	12.00												0.36	11.00		33.00				0.13	4.00		12.00				11.00				0.35	11.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	1		111	01		110	1				30	60	90	2				30		90	30		31													82.99	40	40	40					72.45	35	35	35												40		40					35		35			40				40	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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					39.54	20	20	20												23		23					20		20			23				23	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.10	3.00	6.00	9.00												0.33	10.00		30.00				0.10	3.00		9.00				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	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													254.72	25	25	25					254.06	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	2	Non-Preferred Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.10	3.00	6.00	9.00												0.33	10.00		30.00				0.10	3.00		9.00				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	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					40.14	20	20	20												23		23					20		20			23				23	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		111	01		110	1				30	60	90	2				30		90	30		31													239.31	25	25	25					237.48	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	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													80.32	40	40	40					69.65	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													222.67	25	25	25					220.26	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	3	Preferred Brand	1	2	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					38.99	20	20	20												23		23					20		20			23				23	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.10	3.00	6.00	9.00												0.36	11.00		33.00				0.10	3.00		9.00				11.00				0.35	11.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	1		111	01		110	1				30	60	90	2				30		90	30		31													95.00	39	39	39					85.64	35	35	35												39		39					35		35			39				39	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.10	3.00	6.00	9.00												0.33	10.00		30.00				0.10	3.00		9.00				10.00				0.32	10.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					40.31	20	20	20												23		23					20		20			23				23	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	1		111	01		110	1				30	60	90	2				30		90	30		31													88.72	40	40	40					77.04	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													226.18	25	25	25					224.78	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	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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		111	01		110	1				30	60	90	2				30		90	30		31													219.34	25	25	25					217.36	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	3	Preferred Brand	1	2	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					39.10	20	20	20												23		23					20		20			23				23	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.13	4.00	8.00	12.00												0.36	11.00		33.00				0.13	4.00		12.00				11.00				0.35	11.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	1		111	01		110	1				30	60	90	2				30		90	30		31													95.00	38	38	38					91.95	35	35	35												38		38					35		35			38				38	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		111	01		110	1				30	60	90	2				30		90	30		31													226.11	25	25	25					224.15	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	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	1		111	01		110	1				30	60	90	2				30		90	30		31													81.48	40	40	40					70.97	35	35	35												40		40					35		35			40				40	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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	24	24	24					38.59	20	20	20												24		24					20		20			24				24	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.13	4.00	8.00	12.00												0.36	11.00		33.00				0.13	4.00		12.00				11.00				0.35	11.00		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		111	01		110	1				30	60	90	2				30		90	30		31													234.05	25	25	25					231.45	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	3	Preferred Brand	1	2	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					40.43	20	20	20												23		23					20		20			23				23	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.36	11.00	22.00	33.00					0.13	4.00	8.00	12.00												0.36	11.00		33.00				0.13	4.00		12.00				11.00				0.35	11.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	1		111	01		110	1				30	60	90	2				30		90	30		31													85.92	40	40	40					74.63	35	35	35												40		40					35		35			40				40	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.30	9.00	18.00	27.00					0.10	3.00	6.00	9.00												0.30	9.00		27.00				0.10	3.00		9.00				9.00				0.29	9.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	23	23	23					40.97	20	20	20												23		23					20		20			23				23	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	1		111	01		110	1				30	60	90	2				30		90	30		31													77.14	38	38	38					70.53	35	35	35												38		38					35		35			38				38	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		111	01		110	1				30	60	90	2				30		90	30		31													237.34	25	25	25					235.65	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	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.16	5.00	10.00	15.00					0.03	1.00	2.00	3.00												0.16	5.00		15.00				0.03	1.00		3.00				5.00				0.16	5.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.30	9.00	18.00	27.00					0.10	3.00	6.00	9.00												0.30	9.00		27.00				0.10	3.00		9.00				9.00				0.29	9.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													44.98	23	23	23					38.55	20	20	20												23		23					20		20			23				23	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	1		111	01		110	1				30	60	90	2				30		90	30		31													79.67	38	38	38					68.16	33	33	33												38		38					33		33			38				38	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		111	01		110	1				30	60	90	2				30		90	30		31													213.64	25	25	25					211.23	25	25	25												25		25					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	228	0		29	10	S5617_228_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	228	0		29	10	S5617_228_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	228	0		29	10	S5617_228_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	33	33	33												33		33					33		33			33				33	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		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	229	0		29	10	S5617_229_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	229	0		29	10	S5617_229_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	229	0		29	10	S5617_229_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	229	0		29	10	S5617_229_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	230	0		29	10	S5617_230_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	230	0		29	10	S5617_230_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	230	0		29	10	S5617_230_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	230	0		29	10	S5617_230_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	230	0		29	10	S5617_230_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	230	0		29	10	S5617_230_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	230	0		29	10	S5617_230_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	231	0		29	10	S5617_231_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	231	0		29	10	S5617_231_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	231	0		29	10	S5617_231_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	231	0		29	10	S5617_231_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	231	0		29	10	S5617_231_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	232	0		29	10	S5617_232_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	232	0		29	10	S5617_232_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	232	0		29	10	S5617_232_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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	232	0		29	10	S5617_232_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	232	0		29	10	S5617_232_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	232	0		29	10	S5617_232_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	233	0		29	10	S5617_233_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	233	0		29	10	S5617_233_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	33	33	33												33		33					33		33			33				33	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		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	233	0		29	10	S5617_233_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	233	0		29	10	S5617_233_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	234	0		29	10	S5617_234_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	234	0		29	10	S5617_234_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	234	0		29	10	S5617_234_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	234	0		29	10	S5617_234_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	235	0		29	10	S5617_235_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	235	0		29	10	S5617_235_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	235	0		29	10	S5617_235_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	235	0		29	10	S5617_235_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	235	0		29	10	S5617_235_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	236	0		29	10	S5617_236_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	236	0		29	10	S5617_236_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	236	0		29	10	S5617_236_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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	236	0		29	10	S5617_236_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	236	0		29	10	S5617_236_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	236	0		29	10	S5617_236_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	236	0		29	10	S5617_236_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	237	0		29	10	S5617_237_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		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	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		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	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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	237	0		29	10	S5617_237_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	238	0		29	10	S5617_238_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	238	0		29	10	S5617_238_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	238	0		29	10	S5617_238_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	238	0		29	10	S5617_238_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	238	0		29	10	S5617_238_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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	238	0		29	10	S5617_238_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	238	0		29	10	S5617_238_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	238	0		29	10	S5617_238_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	239	0		29	10	S5617_239_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	239	0		29	10	S5617_239_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	239	0		29	10	S5617_239_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	239	0		29	10	S5617_239_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	239	0		29	10	S5617_239_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	240	0		29	10	S5617_240_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	240	0		29	10	S5617_240_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	240	0		29	10	S5617_240_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	240	0		29	10	S5617_240_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	240	0		29	10	S5617_240_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	240	0		29	10	S5617_240_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	240	0		29	10	S5617_240_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	241	0		29	10	S5617_241_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	241	0		29	10	S5617_241_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	241	0		29	10	S5617_241_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	241	0		29	10	S5617_241_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	241	0		29	10	S5617_241_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	242	0		29	10	S5617_242_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	242	0		29	10	S5617_242_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	242	0		29	10	S5617_242_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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	242	0		29	10	S5617_242_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	242	0		29	10	S5617_242_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	242	0		29	10	S5617_242_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	243	0		29	10	S5617_243_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	243	0		29	10	S5617_243_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	243	0		29	10	S5617_243_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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	243	0		29	10	S5617_243_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	243	0		29	10	S5617_243_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	243	0		29	10	S5617_243_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	243	0		29	10	S5617_243_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	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	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	244	0		29	10	S5617_244_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	244	0		29	10	S5617_244_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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	244	0		29	10	S5617_244_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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	244	0		29	10	S5617_244_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	244	0		29	10	S5617_244_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	244	0		29	10	S5617_244_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	245	0		29	10	S5617_245_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					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	245	0		29	10	S5617_245_0	3	4	Non-Preferred Brand	3	4	100100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				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	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					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	245	0		29	10	S5617_245_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	245	0		29	10	S5617_245_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													354.00	33	33	33					349.11	33	33	33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	245	0		29	10	S5617_245_0	3	3	Preferred Brand	3	4	000001	1	2		111	01		110	1				30	60	90	2				30		90	30		31									1.33	40.00	80.00	120.00					1.00	30.00	60.00	90.00												1.33	40.00		120.00				1.00	30.00		90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5617	245	0		29	10	S5617_245_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.26	8.00	16.00	24.00					0.06	2.00	4.00	6.00												0.26	8.00		24.00				0.06	2.00		6.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	245	0		29	10	S5617_245_0	3	1	Preferred Generic	3	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	245	0		29	10	S5617_245_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					2.83	85.00	170.00	255.00												3.16	95.00		285.00				2.83	85.00		255.00				95.00				3.06	95.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													44.09	22	22	22					39.45	20	20	20												22		22					20		20			22				22	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	1		111	01		110	1				30	60	90	2				30		90	30		31													56.69	40	40	40					48.86	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													385.42	33	33	33					381.14	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	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													56.69	40	40	40					48.86	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													44.09	22	22	22					39.45	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													385.42	33	33	33					381.14	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	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													370.86	33	33	33					366.74	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	1		111	01		110	1				30	60	90	2				30		90	30		31													59.66	40	40	40					51.60	35	35	35												40		40					35		35			40				40	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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	22	22	22					40.67	20	20	20												22		22					20		20			22				22	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													385.42	33	33	33					381.14	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	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													56.69	40	40	40					48.86	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													44.09	22	22	22					39.45	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													56.69	40	40	40					48.86	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													44.09	22	22	22					39.45	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													385.42	33	33	33					381.14	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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													44.09	22	22	22					39.45	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													56.69	40	40	40					48.86	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													385.42	33	33	33					381.14	33	33	33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													51.59	40	40	40					44.24	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.94	22	22	22					39.37	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													369.55	33	33	33					365.61	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.94	22	22	22					39.37	20	20	20												22		22					20		20			22				22	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	1		111	01		110	1				30	60	90	2				30		90	30		31													51.59	40	40	40					44.24	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													369.55	33	33	33					365.61	33	33	33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.94	22	22	22					39.37	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													369.55	33	33	33					365.61	33	33	33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													51.59	40	40	40					44.24	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													51.59	40	40	40					44.24	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.94	22	22	22					39.37	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													369.55	33	33	33					365.61	33	33	33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.94	22	22	22					39.37	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													51.59	40	40	40					44.24	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													369.55	33	33	33					365.61	33	33	33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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		111	01		110	1				30	60	90	2				30		90	30		31													356.50	33	33	33					353.07	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	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													58.12	40	40	40					49.96	35	35	35												40		40					35		35			40				40	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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													44.83	22	22	22					40.24	20	20	20												22		22					20		20			22				22	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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		111	01		110	1				30	60	90	2				30		90	30		31													344.66	33	33	33					342.08	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	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.24	22	22	22					38.70	20	20	20												22		22					20		20			22				22	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	1		111	01		110	1				30	60	90	2				30		90	30		31													55.26	40	40	40					47.54	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.24	22	22	22					38.70	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													55.26	40	40	40					47.54	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													344.66	33	33	33					342.08	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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.24	22	22	22					38.70	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													55.26	40	40	40					47.54	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													344.66	33	33	33					342.08	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	1		111	01		110	1				30	60	90	2				30		90	30		31													55.26	40	40	40					47.54	35	35	35												40		40					35		35			40				40	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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.24	22	22	22					38.70	20	20	20												22		22					20		20			22				22	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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		111	01		110	1				30	60	90	2				30		90	30		31													344.66	33	33	33					342.08	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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													44.83	22	22	22					40.13	20	20	20												22		22					20		20			22				22	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	1		111	01		110	1				30	60	90	2				30		90	30		31													67.62	40	40	40					58.30	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													335.05	33	33	33					332.38	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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.94	22	22	22					39.37	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													51.59	40	40	40					44.24	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													369.55	33	33	33					365.61	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	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													51.59	40	40	40					44.24	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.94	22	22	22					39.37	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													369.55	33	33	33					365.61	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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.94	22	22	22					39.37	20	20	20												22		22					20		20			22				22	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	1		111	01		110	1				30	60	90	2				30		90	30		31													51.59	40	40	40					44.24	35	35	35												40		40					35		35			40				40	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		111	01		110	1				30	60	90	2				30		90	30		31													369.55	33	33	33					365.61	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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.94	22	22	22					39.37	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													51.59	40	40	40					44.24	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													369.55	33	33	33					365.61	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	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													45.00	22	22	22					41.18	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													363.93	33	33	33					361.67	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	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													61.96	40	40	40					53.39	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.24	22	22	22					38.70	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													55.26	40	40	40					47.54	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													344.66	33	33	33					342.08	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	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.13	4.00	8.00	12.00					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		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	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31									0.33	10.00	20.00	30.00					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													55.26	40	40	40					47.54	35	35	35												40		40					35		35			40				40	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	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.24	22	22	22					38.70	20	20	20												22		22					20		20			22				22	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		111	01		110	1				30	60	90	2				30		90	30		31													344.66	33	33	33					342.08	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	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.24	22	22	22					38.70	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													55.26	40	40	40					47.54	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													344.66	33	33	33					342.08	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	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													60.74	40	40	40					52.29	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													42.99	22	22	22					38.57	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													358.16	33	33	33					356.64	33	33	33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													42.99	22	22	22					38.57	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													60.74	40	40	40					52.29	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													358.16	33	33	33					356.64	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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													42.99	22	22	22					38.57	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													60.74	40	40	40					52.29	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													358.16	33	33	33					356.64	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	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													60.74	40	40	40					52.29	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													42.99	22	22	22					38.57	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													358.16	33	33	33					356.64	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	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													42.99	22	22	22					38.57	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													60.74	40	40	40					52.29	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													358.16	33	33	33					356.64	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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													42.99	22	22	22					38.57	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													60.74	40	40	40					52.29	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													358.16	33	33	33					356.64	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	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													43.06	22	22	22					38.49	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													442.68	33	33	33					440.32	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	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													62.60	40	40	40					54.04	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													42.99	22	22	22					38.57	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													60.74	40	40	40					52.29	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													358.16	33	33	33					356.64	33	33	33												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	3	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					0.03	1.00	2.00	3.00												0.13	4.00		12.00				0.03	1.00		3.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	3	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					0.13	4.00	8.00	12.00												0.33	10.00		30.00				0.13	4.00		12.00				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	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31													60.74	40	40	40					52.29	35	35	35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	3	3	Preferred Brand	1	4	000001	1	1		111	01		110	1				30	60	90	2				30		90	30		31													42.99	22	22	22					38.57	20	20	20												22		22					20		20			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31													358.16	33	33	33					356.64	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	3	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													88.67	50		50					85.24	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													40.50	25		25					37.00	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		24.00					.06	2.00		6.00															11.00							6.00				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	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													44.13	23		23					40.27	21		21														25							25			23				23	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		30.00					.12	4.00		12.00															17.00							12.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													74.00	50		50					69.90	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.62	25		25					40.15	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.29	9.00		27.00					.09	3.00		9.00															14.00							9.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													74.51	50		50					71.10	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.29	9.00		27.00					.09	3.00		9.00															14.00							9.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.61	25		25					39.83	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													81.95	50		50					76.66	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		24.00					.06	2.00		6.00															11.00							6.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													42.84	25		25					39.24	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													80.79	50		50					78.93	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		30.00					.12	4.00		12.00															17.00							12.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													42.05	25		25					38.59	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													67.05	50		50					64.31	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		30.00					.12	4.00		12.00															17.00							12.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													44.03	25		25					39.79	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													60.86	50		50					56.54	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.29	9.00		27.00					.09	3.00		9.00															14.00							9.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													44.79	25		25					40.94	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													68.27	50		50					64.52	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													63.26	50		50					58.53	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													44.18	25		25					40.14	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		30.00					.12	4.00		12.00															17.00							12.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		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	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		30.00					.12	4.00		12.00															17.00							12.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.84	24		24					40.84	22		22														25							25			24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													69.48	50		50					66.19	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													71.68	50		50					66.95	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.73	24		24					39.75	22		22														25							25			24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.35	11.00		33.00					.16	5.00		15.00															20.00							15.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.35	11.00		33.00					.16	5.00		15.00															20.00							15.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.68	24		24					40.20	22		22														25							25			24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													71.09	50		50					69.74	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		24.00					.06	2.00		6.00															11.00							6.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.01	25		25					39.57	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													68.25	50		50					65.65	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		30.00					.12	4.00		12.00															17.00							12.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													71.64	50		50					68.09	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.48	24		24					39.75	22		22														25							25			24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.38	12.00		36.00					.19	6.00		18.00															23.00							18.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.48	24		24					38.12	22		22														25							25			24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													82.55	50		50					73.09	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.35	11.00		33.00					.16	5.00		15.00															20.00							15.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													40.82	25		25					37.36	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													62.60	50		50					57.64	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													71.74	50		50					67.46	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.91	25		25					39.60	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.35	11.00		33.00					.16	5.00		15.00															20.00							15.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													83.30	50		50					76.94	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													44.31	24		24					40.23	22		22														25							25			24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.35	11.00		33.00					.16	5.00		15.00															20.00							15.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.38	21		21					38.25	19		19														25							25			21				21	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.45	14.00		42.00					.25	8.00		24.00															29.00							24.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													54.47	50		50					51.09	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													72.48	50		50					68.99	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.62	24		24					39.86	22		22														25							25			24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.38	12.00		36.00					.19	6.00		18.00															23.00							18.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													67.87	50		50					65.32	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													39.39	25		25					36.07	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.35	11.00		33.00					.16	5.00		15.00															20.00							15.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													79.08	50		50					72.12	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.25	24		24					38.81	22		22														25							25			24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.38	12.00		36.00					.19	6.00		18.00															23.00							18.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.35	11.00		33.00					.16	5.00		15.00															20.00							15.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.38	25		25					37.30	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													67.81	50		50					58.02	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													70.71	50		50					63.73	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													41.01	25		25					37.26	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.35	11.00		33.00					.16	5.00		15.00															20.00							15.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													63.69	50		50					53.92	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													41.93	25		25					37.19	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.35	11.00		33.00					.16	5.00		15.00															20.00							15.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		24.00					.06	2.00		6.00															11.00							6.00				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	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													36.40	25		25					33.82	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													53.89	50		50					52.33	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.35	11.00		33.00					.16	5.00		15.00															20.00							15.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													40.83	25		25					37.54	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													56.45	50		50					53.68	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													68.47	50		50					63.22	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													42.85	19		19					36.58	17		17														25							25			19				19	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.45	14.00		42.00					.25	8.00		24.00															29.00							24.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													78.64	50		50					73.75	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.96	25		25					39.97	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		30.00					.12	4.00		12.00															17.00							12.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													90.53	50		50					86.97	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.84	23		23					39.66	21		21														25							25			23				23	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		30.00					.12	4.00		12.00															17.00							12.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													61.86	50		50					62.67	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													41.75	25		25					39.57	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.35	11.00		33.00					.16	5.00		15.00															20.00							15.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													69.13	50		50					72.63	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													43.44	24		24					41.52	22		22														25							25			24				24	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		30.00					.12	4.00		12.00															17.00							12.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													38.50	25		25					28.15	18		18														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		24.00					.06	2.00		6.00															11.00							6.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													60.39	50		50					56.68	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				31		90	2						90	31		31									.38	12.00		36.00					.19	6.00		18.00															23.00							18.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	2	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	2						90	31		31													41.68	25		25					37.34	23		23														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	2						90	31		31													64.97	50		50					57.50	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31														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	2	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	2						90	31		31									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													69.51	50		50					66.13	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													31.07	50		50					29.68	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													29.42	50		50					27.73	48		48														50							50			50				50	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														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													43.15	50		50					43.43	48		48														50							50			50				50	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									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				8.00				.25	8.00		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									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													32.99	50		50					31.25	48		48														50							50			50				50	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									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													44.17	50		50					43.31	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													35.80	50		50					34.04	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													34.54	50		50					32.96	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													55.37	50		50					53.04	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													77.58	50		50					78.18	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													44.17	50		50					42.66	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													34.30	50		50					32.88	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													62.16	50		50					59.74	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													74.78	50		50					72.68	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													68.24	50		50					81.89	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													59.24	50		50					57.77	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													59.95	50		50					57.59	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													68.82	50		50					68.84	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													52.27	50		50					49.07	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													65.25	50		50					60.28	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													63.13	50		50					62.13	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													66.91	50		50					64.24	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	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	1		110	01		100	1				31		90	2						90	31		31													70.10	50		50					67.96	48		48														50							50			50				50	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									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	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									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	1		110	01		100	1				31		90	2						90	31		31													68.50	50		50					68.93	48		48														50							50			50				50	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														31								31														31							31					31				31	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									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													68.61	50		50					68.02	48		48														50							50			50				50	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														31								31														31							31					31				31	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									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	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	1		110	01		100	1				31		90	2						90	31		31													67.50	50		50					66.09	48		48														50							50			50				50	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									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				45.00				1.45	45.00		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	1		110	01		100	1				31		90	2						90	31		31													67.03	50		50					66.83	48		48														50							50			50				50	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														31								31														31							31					31				31	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									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													68.36	50		50					68.27	48		48														50							50			50				50	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									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													59.29	50		50					70.98	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													64.18	50		50					67.87	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	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									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	1		110	01		100	1				31		90	2						90	31		31													67.26	50		50					67.82	48		48														50							50			50				50	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														31								31														31							31					31				31	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									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	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	1		110	01		100	1				31		90	2						90	31		31													66.57	50		50					66.90	48		48														50							50			50				50	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									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	1		110	01		100	1				31		90	2						90	31		31													67.22	50		50					67.69	48		48														50							50			50				50	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														31								31														31							31					31				31	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									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	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	1		110	01		100	1				31		90	2						90	31		31													67.96	50		50					65.32	48		48														50							50			50				50	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									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	7	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	7	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	7	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	7	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1010.00	25		25					1010.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.66	80.00		240.00								285.00																		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	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.33	40.00		120.00					1.10	33.00		99.00								120.00																		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	6	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					.06	2.00		6.00								21.00																		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	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	6	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	6	5	Specialty Tier	3	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	002	0		29	10	S5715_002_0	6	4	Non-Preferred Brand	3	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.66	80.00		240.00								285.00																		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	6	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.33	40.00		120.00					1.10	33.00		99.00								120.00																		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	6	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.23	7.00		21.00					.06	2.00		6.00								21.00																		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	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	003	0		29	10	S5715_003_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	6	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_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					0.00	0.00		0.00								15.00																		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	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	6	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1010.00	25		25					1010.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	6	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					.06	2.00		6.00								21.00																		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	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					0.00	0.00		0.00								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.33	40.00		120.00					1.10	33.00		99.00								120.00																		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	6	5	Specialty Tier	3	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	6	4	Non-Preferred Brand	3	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.66	80.00		240.00								285.00																		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	6	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.33	40.00		120.00					1.10	33.00		99.00								120.00																		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	6	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.23	7.00		21.00					.06	2.00		6.00								21.00																		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	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		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	6	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.66	80.00		240.00								285.00																		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	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.46	44.00		132.00					1.30	39.00		117.00								132.00																		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	6	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_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					0.00	0.00		0.00								15.00																		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	6	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1010.00	25		25					1010.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		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	6	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.66	80.00		240.00								285.00																		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	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.33	40.00		120.00					1.10	33.00		99.00								120.00																		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	6	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.23	7.00		21.00					.06	2.00		6.00								21.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	006	0		29	10	S5715_006_0	6	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.33	40.00		120.00					1.10	33.00		99.00								120.00																		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	6	5	Specialty Tier	3	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	6	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					.06	2.00		6.00								21.00																		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	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	6	4	Non-Preferred Brand	3	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.66	80.00		240.00								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5715	010	0		29	10	S5715_010_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.83	85.00		255.00								285.00																		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	6	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1010.00	25		25					1010.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	6	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.36	11.00		33.00					.20	6.00		18.00								33.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.40	42.00		126.00					1.23	37.00		111.00								126.00																		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	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.66	80.00		240.00								285.00																		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	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.33	40.00		120.00					1.10	33.00		99.00								120.00																		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	6	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					.06	2.00		6.00								21.00																		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	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	6	5	Specialty Tier	3	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	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	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.00	0.00		0.00								15.00																		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	6	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									.23	7.00		21.00					.06	2.00		6.00								21.00																		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	6	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.33	40.00		120.00					1.10	33.00		99.00								120.00																		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	6	4	Non-Preferred Brand	3	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					2.66	80.00		240.00								285.00																		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	6	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1330.00	33		33					1330.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	3	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		90	1							30		31													1010.00	25		25					1010.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_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					3.00	90.00		270.00								285.00																		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	3	3	Preferred Brand	1	2	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		135.00					1.33	40.00		120.00								135.00																		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	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.16	5.00		15.00								30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	3	1	Preferred Generic	1	2	001000	1	2		110	01	100		1				30		90	1			90				30		31									.20	6.00		18.00					.03	1.00		3.00								18.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	4	2	Non-Preferred Generic	1	2	000100	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.13	4.00		12.00								30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	4	1	Preferred Generic	1	2	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					0.00	0.00		0.00								15.00																		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	4	3	Preferred Brand	1	2	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		135.00					1.33	40.00		120.00								135.00																		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	4	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					3.00	90.00		270.00								285.00																		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	4	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		90	1							30		31													1010.00	25		25					1010.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	3	1	Preferred Generic	1	2	001000	1	2		110	01	100		1				30		90	1			90				30		31									.20	6.00		18.00					.03	1.00		3.00								18.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	3	3	Preferred Brand	1	2	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		135.00					1.33	40.00		120.00								135.00																		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	3	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		90	1							30		31													1010.00	25		25					1010.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	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					3.00	90.00		270.00								285.00																		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	3	1	Preferred Generic	1	2	001000	1	2		110	01	100		1				30		90	1			90				30		31									.20	6.00		18.00					.03	1.00		3.00								18.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.36	11.00		33.00					0.20	6.00		18.00								33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_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					3.00	90.00		270.00								285.00																		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	3	3	Preferred Brand	1	2	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		135.00					1.30	39.00		117.00								135.00																		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	3	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		90	1							30		31													1010.00	25		25					1010.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	4	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													66.71	35	35	35					62.90	33	33	33					33	33	33																	35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.06	32.00	64.00	96.00					0.90	27.00	54.00	81.00					0.90	27.00	81.00	81.00																		32.00				0.94	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.43	13.00	26.00	39.00					0.16	5.00	10.00	15.00					0.16	5.00	10.00	10.00																		13.00				0.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	4	5	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, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													71.51	40	40	40					67.94	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	014	0		29	10	S5726_014_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					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	4	5	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, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5726	015	0		29	10	S5726_015_0	3	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	015	0		29	10	S5726_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									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	015	0		29	10	S5726_015_0	3	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.50	45.00	90.00	135.00					1.33	40.00	80.00	120.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	015	0		29	10	S5726_015_0	3	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													76.04	40	40	40					72.24	38	38	38					38	38	38																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	015	0		29	10	S5726_015_0	3	5	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, Specialty Tier												
S5726	015	0		29	10	S5726_015_0	3	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.03	1.00	2.00	3.00					0.03	1.00	2.00	2.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5726	015	0		29	10	S5726_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									0.56	17.00	34.00	51.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	6.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5726	015	0		29	10	S5726_015_0	3	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.91	65	65	65					60.96	64	64	64					65	65	65																	65				65	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5743	001	0		29	10	S5743_001_0	8	3	Preferred Brand	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.73	22.00	44.00	66.00																					.73	22.00	44.00	44.00																		22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	001	0		29	10	S5743_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	.20	6.00	12.00	18.00																					.20	6.00	12.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	001	0		29	10	S5743_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												
S5743	001	0		29	10	S5743_001_0	8	4	Non-Preferred Brand	1	2	110000	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												
S5743	001	0		29	10	S5743_001_0	8	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					228.02	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.80	24.00	48.00	72.00																					.80	24.00	48.00	48.00																		24.00				.77	24.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	004	0		29	10	S5743_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	.10	3.00	6.00	9.00																					.10	3.00	6.00	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.03	1.00	2.00	3.00																					.03	1.00	2.00	2.00																		1.00				.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	004	0		29	10	S5743_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					61.72	50	50	50																					50	50	50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	7	3	Preferred Brand	3	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.80	24.00	48.00	72.00																					.80	24.00	48.00	48.00																		24.00				.77	24.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5743	004	0		29	10	S5743_004_0	7	2	Non-Preferred Generic	3	4	000100	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	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5743	004	0		29	10	S5743_004_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.03	1.00	2.00	3.00																					.03	1.00	2.00	2.00																		1.00				.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5743	004	0		29	10	S5743_004_0	7	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					262.09	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	007	0		29	10	S5743_007_0	4	4	Non-Preferred Brand	1	4	100000	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31													55.23	50	50	50					54.03	50	50	50												50	50	50					50	50	50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	007	0		29	10	S5743_007_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					1.16	35.00	70.00	105.00												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												
S5743	007	0		29	10	S5743_007_0	4	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					.20	6.00	12.00	18.00												.40	12.00	24.00	24.00				.20	6.00	12.00	12.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	007	0		29	10	S5743_007_0	4	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	15.00					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, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	007	0		29	10	S5743_007_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31													255.06	29	29	29					245.25	29	29	29												29	29	29					29	29	29			29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	1	2	Non-Preferred Generic	1	3	000100	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	0.48	15.00	30.00	45.00																					0.48	15.00	30.00	37.50																			15.00			0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	1	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	1	4	Non-Preferred Brand	1	3	100000	1	1	111		10	111		1	31	60	90				1	31	60	90					29	31					86.43	49	49	49																					49	49	49																		49			49	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	1	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	006	0		29	10	S5753_006_0	1	1	Preferred Generic	1	3	001000	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	0.12	4.00	8.00	12.00																					0.12	4.00	8.00	10.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	1	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																					0.09	3.00	6.00	7.50																			3.00			0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	1	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	1	4	Non-Preferred Brand	1	4	100000	1	1	111		10	111		1	31	60	90				1	31	60	90					29	31					83.76	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	1	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	1	1	Preferred Generic	3	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																					0.09	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	1	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	1	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												
S5755	006	0		29	10	S5755_006_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	5	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													75.99	50							59.25	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	006	0		29	10	S5755_006_0	5	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	5	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															45.00							39.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	006	0		29	10	S5755_006_0	5	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	5	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	006	0		29	10	S5755_006_0	5	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	007	0		29	10	S5755_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		113.00					1.23	37.00		93.00															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	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	007	0		29	10	S5755_007_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	007	0		29	10	S5755_007_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								30														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	007	0		29	10	S5755_007_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													72.26	50							56.35	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	007	0		29	10	S5755_007_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													70.45	50							54.06	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	008	0		29	10	S5755_008_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	008	0		29	10	S5755_008_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	009	0		29	10	S5755_009_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	009	0		29	10	S5755_009_0	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.15	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	009	0		29	10	S5755_009_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													70.40	50							54.50	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	009	0		29	10	S5755_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		113.00					1.23	37.00		93.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	010	0		29	10	S5755_010_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													64.11	50							49.40	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	010	0		29	10	S5755_010_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	011	0		29	10	S5755_011_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	011	0		29	10	S5755_011_0	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	011	0		29	10	S5755_011_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													66.72	50							51.37	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	011	0		29	10	S5755_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		113.00					1.23	37.00		93.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	5	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	012	0		29	10	S5755_012_0	5	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	5	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	5	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															113.00							90.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	012	0		29	10	S5755_012_0	5	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													62.47	50							48.03	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	012	0		29	10	S5755_012_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	5	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	013	0		29	10	S5755_013_0	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	013	0		29	10	S5755_013_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													61.60	50							48.42	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	013	0		29	10	S5755_013_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	013	0		29	10	S5755_013_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	014	0		29	10	S5755_014_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	014	0		29	10	S5755_014_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													67.40	50							53.31	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	015	0		29	10	S5755_015_0	5	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	5	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													58.56	50							45.68	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	015	0		29	10	S5755_015_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	5	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	015	0		29	10	S5755_015_0	5	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	015	0		29	10	S5755_015_0	5	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	5	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													69.49	50							53.08	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	016	0		29	10	S5755_016_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								30														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	016	0		29	10	S5755_016_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	016	0		29	10	S5755_016_0	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	017	0		29	10	S5755_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		113.00					1.23	37.00		93.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													71.38	50							55.07	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	017	0		29	10	S5755_017_0	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	017	0		29	10	S5755_017_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	017	0		29	10	S5755_017_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	018	0		29	10	S5755_018_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													66.33	50							52.08	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	018	0		29	10	S5755_018_0	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	020	0		29	10	S5755_020_0	5	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															45.00							39.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	020	0		29	10	S5755_020_0	5	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	5	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	020	0		29	10	S5755_020_0	5	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	020	0		29	10	S5755_020_0	5	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													70.42	50							54.53	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	020	0		29	10	S5755_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		113.00					1.23	37.00		93.00															113.00							90.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	021	0		29	10	S5755_021_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															113.00							90.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	021	0		29	10	S5755_021_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													68.27	50							53.96	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	021	0		29	10	S5755_021_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	021	0		29	10	S5755_021_0	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	022	0		29	10	S5755_022_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													24.53	29							20.61	24														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	022	0		29	10	S5755_022_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													14.41	19		19					10.75	14		14														19							19			19				19	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	022	0		29	10	S5755_022_0	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	023	0		29	10	S5755_023_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	5	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	023	0		29	10	S5755_023_0	5	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	023	0		29	10	S5755_023_0	5	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													64.89	50							50.30	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	023	0		29	10	S5755_023_0	5	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															113.00							90.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	023	0		29	10	S5755_023_0	5	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	5	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	024	0		29	10	S5755_024_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	024	0		29	10	S5755_024_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													65.33	50							50.81	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	024	0		29	10	S5755_024_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													67.58	50							52.63	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	025	0		29	10	S5755_025_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	025	0		29	10	S5755_025_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	026	0		29	10	S5755_026_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													63.95	50							49.19	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	026	0		29	10	S5755_026_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	026	0		29	10	S5755_026_0	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	028	0		29	10	S5755_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		113.00					1.23	37.00		93.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															27.00							0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	028	0		29	10	S5755_028_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													69.91	50							54.08	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	028	0		29	10	S5755_028_0	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	028	0		29	10	S5755_028_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	028	0		29	10	S5755_028_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															113.00							90.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	029	0		29	10	S5755_029_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	029	0		29	10	S5755_029_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													56.58	50							44.83	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	029	0		29	10	S5755_029_0	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	030	0		29	10	S5755_030_0	3	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								30														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	030	0		29	10	S5755_030_0	3	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													68.40	50							53.03	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	030	0		29	10	S5755_030_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	3	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	031	0		29	10	S5755_031_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													65.82	50							51.90	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	031	0		29	10	S5755_031_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	031	0		29	10	S5755_031_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	5	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	5	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	5	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	5	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	032	0		29	10	S5755_032_0	5	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	032	0		29	10	S5755_032_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								30														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	032	0		29	10	S5755_032_0	5	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													63.07	50							49.81	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	033	0		29	10	S5755_033_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	3	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													66.94	50							52.10	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	033	0		29	10	S5755_033_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	3	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													61.55	50							47.38	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	034	0		29	10	S5755_034_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	3	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	3	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															27.00							0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	034	0		29	10	S5755_034_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													64.90	50							51.42	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	035	0		29	10	S5755_035_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								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	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31													28.56	45		45					25.39	40		40														45							40			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	035	0		29	10	S5755_035_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															113.00							90.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	035	0		29	10	S5755_035_0	4	4	Non-Preferred Brand	3	4	110000	1	1		010	01		010	1				30							30			30		31													62.03	45							55.14	40														45							40					45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	038	0		29	10	S5755_038_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															27.00							0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													21.51	22		22					17.25	17		17														22							22			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													36.26	32							31.04	27														32							32					32				32	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	039	0		29	10	S5755_039_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													15.17	20		20					11.90	15		15														20							20			20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	039	0		29	10	S5755_039_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													26.44	30							22.92	25														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	039	0		29	10	S5755_039_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	073	0		29	10	S5755_073_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													19.17	22		22					15.39	17		17														22							22			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	073	0		29	10	S5755_073_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													32.91	32							30.51	27														32							32					32				32	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	073	0		29	10	S5755_073_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	074	0		29	10	S5755_074_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															27.00							0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	074	0		29	10	S5755_074_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													23.16	22		22					18.65	17		17														22							22			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	074	0		29	10	S5755_074_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													31.91	32							28.04	27														32							32					32				32	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													30.60	31							25.78	26														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													17.49	21		21					13.36	16		16														21							21			21				21	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													16.02	21		21					12.35	16		16														21							21			21				21	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													29.03	31							24.80	26														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													15.13	20		20					11.37	15		15														20							20			20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													27.27	30							22.81	25														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	078	0		29	10	S5755_078_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													15.48	20		20					11.64	15		15														20							20			20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	078	0		29	10	S5755_078_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													28.63	30							24.26	25														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													17.24	21		21					13.17	16		16														21							21			21				21	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													29.44	31							24.86	26														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	4	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	4	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													16.95	20		20					12.93	15		15														20							20			20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	080	0		29	10	S5755_080_0	4	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													30.07	30							24.81	25														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	080	0		29	10	S5755_080_0	4	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	081	0		29	10	S5755_081_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	081	0		29	10	S5755_081_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													15.84	20		20					11.95	15		15														20							20			20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	081	0		29	10	S5755_081_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													30.36	30							25.57	25														30							30					30				30	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	1		110	01		100	1				30		90	1						90	30		31													25.32	23		23					20.58	18		18														23							23			23				23	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	1		010	01		010	1				30							30			30		31													36.87	33							31.64	28														33							33					33				33	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									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		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		010	01		010	1				30							30			30		31														25								25														25							25					25				25	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									0.30	9.00		27.00					0.00	0.00		0.00															27.00							0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															27.00							0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													26.90	29							22.32	24														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													15.06	19		19					11.25	14		14														19							19			19				19	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													26.70	30							22.33	25														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	084	0		29	10	S5755_084_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													16.06	20		20					12.06	15		15														20							20			20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	084	0		29	10	S5755_084_0	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	084	0		29	10	S5755_084_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	085	0		29	10	S5755_085_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													16.67	21		21					12.87	16		16														21							21			21				21	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	085	0		29	10	S5755_085_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													29.18	31							24.61	26														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	085	0		29	10	S5755_085_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	086	0		29	10	S5755_086_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													16.48	20		20					12.40	15		15														20							20			20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	086	0		29	10	S5755_086_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													28.72	30							24.06	25														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	086	0		29	10	S5755_086_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	087	0		29	10	S5755_087_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															27.00							0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	087	0		29	10	S5755_087_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													15.53	20		20					11.77	15		15														20							20			20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	087	0		29	10	S5755_087_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													27.74	30							23.50	25														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													13.52	19		19					10.00	14		14														19							19			19				19	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													26.26	29							21.83	24														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	089	0		29	10	S5755_089_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													34.81	33							31.52	28														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	089	0		29	10	S5755_089_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													20.68	23		23					16.75	18		18														23							23			23				23	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	089	0		29	10	S5755_089_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													15.15	19		19					11.18	14		14														19							19			19				19	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													28.85	29							23.98	24														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													27.80	30							23.55	25														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													15.92	20		20					12.12	15		15														20							20			20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													35.10	31							29.97	26														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													18.88	21		21					14.67	16		16														21							21			21				21	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	094	0		29	10	S5755_094_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													25.91	30							22.09	25														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	094	0		29	10	S5755_094_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													14.97	20		20					11.55	15		15														20							20			20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	094	0		29	10	S5755_094_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	095	0		29	10	S5755_095_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													17.70	21		21					13.89	16		16														21							21			21				21	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	095	0		29	10	S5755_095_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													32.01	31							28.19	26														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	095	0		29	10	S5755_095_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													17.06	21		21					13.44	16		16														21							21			21				21	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	096	0		29	10	S5755_096_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													29.87	31							25.45	26														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	096	0		29	10	S5755_096_0	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	096	0		29	10	S5755_096_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													19.28	21		21					14.98	16		16														21							21			21				21	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	097	0		29	10	S5755_097_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													29.87	31							27.23	26														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	097	0		29	10	S5755_097_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	097	0		29	10	S5755_097_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	098	0		29	10	S5755_098_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													18.74	21		21					15.23	16		16														21							21			21				21	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	098	0		29	10	S5755_098_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													32.85	31							29.24	26														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	098	0		29	10	S5755_098_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	099	0		29	10	S5755_099_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													15.15	20		20					11.44	15		15														20							20			20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	099	0		29	10	S5755_099_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													29.04	30							24.31	25														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	099	0		29	10	S5755_099_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	100	0		29	10	S5755_100_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													21.19	22		22					17.16	17		17														22							22			22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	100	0		29	10	S5755_100_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													36.60	32							32.43	27														32							32					32				32	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	100	0		29	10	S5755_100_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													26.17	30							21.88	25														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	101	0		29	10	S5755_101_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													14.49	20		20					10.91	15		15														20							20			20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	101	0		29	10	S5755_101_0	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	101	0		29	10	S5755_101_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	102	0		29	10	S5755_102_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													13.89	19		19					10.26	14		14														19							19			19				19	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	102	0		29	10	S5755_102_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													25.28	29							21.02	24														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	102	0		29	10	S5755_102_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.36	11.00		33.00					0.10	3.00		9.00															33.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	3	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31													18.27	21		21					14.19	16		16														21							21			21				21	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	3	4	Non-Preferred Brand	1	2	110000	1	1		010	01		010	1				30							30			30		31													27.87	31							24.22	26														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	3	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	3	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													61.10	50							46.44	40														50							40					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	106	0		29	10	S5755_106_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		113.00					1.23	37.00		93.00															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	3	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									0.50	15.00		45.00					0.23	7.00		21.00															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	3	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.30	9.00		27.00					0.00	0.00		0.00															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	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														30								30														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	107	0		29	10	S5755_107_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	107	0		29	10	S5755_107_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	107	0		29	10	S5755_107_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					1.16	35.00		105.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	107	0		29	10	S5755_107_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													51.94	50							40.76	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	107	0		29	10	S5755_107_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	108	0		29	10	S5755_108_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	108	0		29	10	S5755_108_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	108	0		29	10	S5755_108_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					1.16	35.00		105.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	108	0		29	10	S5755_108_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													52.84	50							41.37	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	108	0		29	10	S5755_108_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	109	0		29	10	S5755_109_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	109	0		29	10	S5755_109_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	109	0		29	10	S5755_109_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					1.00	30.00		90.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	109	0		29	10	S5755_109_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	109	0		29	10	S5755_109_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													58.79	50							46.36	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	110	0		29	10	S5755_110_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	110	0		29	10	S5755_110_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	110	0		29	10	S5755_110_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					1.00	30.00		90.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	110	0		29	10	S5755_110_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													54.48	50							42.79	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	110	0		29	10	S5755_110_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	111	0		29	10	S5755_111_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	111	0		29	10	S5755_111_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	111	0		29	10	S5755_111_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													54.20	50							42.72	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	111	0		29	10	S5755_111_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					0.80	24.00		72.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	111	0		29	10	S5755_111_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	112	0		29	10	S5755_112_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	112	0		29	10	S5755_112_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					0.80	24.00		72.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	112	0		29	10	S5755_112_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													52.35	50							41.11	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	112	0		29	10	S5755_112_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	112	0		29	10	S5755_112_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	113	0		29	10	S5755_113_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	113	0		29	10	S5755_113_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	113	0		29	10	S5755_113_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					1.00	30.00		90.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	113	0		29	10	S5755_113_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													52.69	50							41.26	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	113	0		29	10	S5755_113_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	114	0		29	10	S5755_114_0	5	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	114	0		29	10	S5755_114_0	5	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	114	0		29	10	S5755_114_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					0.80	24.00		72.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	114	0		29	10	S5755_114_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	114	0		29	10	S5755_114_0	5	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													53.44	50							42.04	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	115	0		29	10	S5755_115_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	115	0		29	10	S5755_115_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	115	0		29	10	S5755_115_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													53.52	50							42.18	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	115	0		29	10	S5755_115_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					0.80	24.00		72.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	115	0		29	10	S5755_115_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	116	0		29	10	S5755_116_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														26								26														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	116	0		29	10	S5755_116_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	116	0		29	10	S5755_116_0	3	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	116	0		29	10	S5755_116_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.16	35.00		105.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	116	0		29	10	S5755_116_0	3	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													56.02	50							43.76	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	117	0		29	10	S5755_117_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	117	0		29	10	S5755_117_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	117	0		29	10	S5755_117_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					0.63	19.00		57.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	117	0		29	10	S5755_117_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													50.89	50							40.13	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	117	0		29	10	S5755_117_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	118	0		29	10	S5755_118_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	118	0		29	10	S5755_118_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	118	0		29	10	S5755_118_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					0.80	24.00		72.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	118	0		29	10	S5755_118_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	118	0		29	10	S5755_118_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													50.60	50							39.57	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	119	0		29	10	S5755_119_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	119	0		29	10	S5755_119_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	119	0		29	10	S5755_119_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													53.11	50							41.72	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	119	0		29	10	S5755_119_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					1.00	30.00		90.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	119	0		29	10	S5755_119_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	120	0		29	10	S5755_120_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	120	0		29	10	S5755_120_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	120	0		29	10	S5755_120_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					0.80	24.00		72.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	120	0		29	10	S5755_120_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													52.65	50							41.43	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	120	0		29	10	S5755_120_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	121	0		29	10	S5755_121_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													49.55	50							38.84	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	121	0		29	10	S5755_121_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					0.80	24.00		72.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	121	0		29	10	S5755_121_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	121	0		29	10	S5755_121_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	121	0		29	10	S5755_121_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	122	0		29	10	S5755_122_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	122	0		29	10	S5755_122_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	122	0		29	10	S5755_122_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					0.63	19.00		57.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	122	0		29	10	S5755_122_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													52.33	50							41.04	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	122	0		29	10	S5755_122_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	123	0		29	10	S5755_123_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	123	0		29	10	S5755_123_0	3	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	123	0		29	10	S5755_123_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.16	35.00		105.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	123	0		29	10	S5755_123_0	3	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													53.69	50							42.10	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	123	0		29	10	S5755_123_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														26								26														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	124	0		29	10	S5755_124_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													52.17	50							41.05	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	124	0		29	10	S5755_124_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					0.63	19.00		57.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	124	0		29	10	S5755_124_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	124	0		29	10	S5755_124_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	124	0		29	10	S5755_124_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	125	0		29	10	S5755_125_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	125	0		29	10	S5755_125_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													52.70	50							41.46	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	125	0		29	10	S5755_125_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	125	0		29	10	S5755_125_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	125	0		29	10	S5755_125_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					0.80	24.00		72.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	126	0		29	10	S5755_126_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													56.10	50							44.11	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	126	0		29	10	S5755_126_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					1.00	30.00		90.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	126	0		29	10	S5755_126_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	126	0		29	10	S5755_126_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	126	0		29	10	S5755_126_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	127	0		29	10	S5755_127_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	127	0		29	10	S5755_127_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	127	0		29	10	S5755_127_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					0.80	24.00		72.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	127	0		29	10	S5755_127_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	127	0		29	10	S5755_127_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													53.33	50							42.03	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	128	0		29	10	S5755_128_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	128	0		29	10	S5755_128_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	128	0		29	10	S5755_128_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					1.00	30.00		90.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	128	0		29	10	S5755_128_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													52.27	50							41.05	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	128	0		29	10	S5755_128_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	129	0		29	10	S5755_129_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	129	0		29	10	S5755_129_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	129	0		29	10	S5755_129_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													50.30	50							39.35	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	129	0		29	10	S5755_129_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					1.00	30.00		90.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	129	0		29	10	S5755_129_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	130	0		29	10	S5755_130_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	130	0		29	10	S5755_130_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	130	0		29	10	S5755_130_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					1.00	30.00		90.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	130	0		29	10	S5755_130_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													51.23	50							40.21	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	130	0		29	10	S5755_130_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	131	0		29	10	S5755_131_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	131	0		29	10	S5755_131_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	131	0		29	10	S5755_131_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					0.80	24.00		72.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	131	0		29	10	S5755_131_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													52.14	50							41.16	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	131	0		29	10	S5755_131_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	132	0		29	10	S5755_132_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	132	0		29	10	S5755_132_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	132	0		29	10	S5755_132_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					1.16	35.00		105.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	132	0		29	10	S5755_132_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	132	0		29	10	S5755_132_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													52.79	50							41.50	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	133	0		29	10	S5755_133_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	133	0		29	10	S5755_133_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	133	0		29	10	S5755_133_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					1.00	30.00		90.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	133	0		29	10	S5755_133_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													53.74	50							42.25	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	133	0		29	10	S5755_133_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	134	0		29	10	S5755_134_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31									0.33	10.00		30.00					0.00	0.00		0.00															30.00							0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	134	0		29	10	S5755_134_0	4	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31									1.10	33.00		99.00					0.10	3.00		9.00															99.00							99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	134	0		29	10	S5755_134_0	4	4	Non-Preferred Brand	1	4	110000	1	1		010	01		010	1				30							30			30		31													56.14	50							44.08	40														50							50					50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	134	0		29	10	S5755_134_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					1.16	35.00		105.00															135.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	134	0		29	10	S5755_134_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														27								27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	125	0		29	10	S5768_125_0	2	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	125	0		29	10	S5768_125_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													49.71	50	50	50					42.68	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	126	0		29	10	S5768_126_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	2	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	126	0		29	10	S5768_126_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													47.69	50	50	50					45.08	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	127	0		29	10	S5768_127_0	2	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	127	0		29	10	S5768_127_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													49.84	50	50	50					45.42	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	128	0		29	10	S5768_128_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													48.80	50	50	50					44.22	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	2	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	128	0		29	10	S5768_128_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	2	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	129	0		29	10	S5768_129_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	129	0		29	10	S5768_129_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													44.74	50	50	50					40.64	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	130	0		29	10	S5768_130_0	2	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	130	0		29	10	S5768_130_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													44.77	50	50	50					40.12	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	2	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	131	0		29	10	S5768_131_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	131	0		29	10	S5768_131_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													45.70	50	50	50					40.63	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													41.04	50	50	50					37.87	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	2	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	132	0		29	10	S5768_132_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	132	0		29	10	S5768_132_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	133	0		29	10	S5768_133_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													42.43	50	50	50					38.89	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	134	0		29	10	S5768_134_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	134	0		29	10	S5768_134_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	134	0		29	10	S5768_134_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													45.67	50	50	50					41.95	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	135	0		29	10	S5768_135_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	135	0		29	10	S5768_135_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													40.08	50	50	50					35.55	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													44.53	50	50	50					41.18	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	136	0		29	10	S5768_136_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	136	0		29	10	S5768_136_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	137	0		29	10	S5768_137_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													43.99	50	50	50					40.00	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	138	0		29	10	S5768_138_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	138	0		29	10	S5768_138_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	138	0		29	10	S5768_138_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													42.91	50	50	50					39.57	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													47.39	50	50	50					44.04	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	139	0		29	10	S5768_139_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	139	0		29	10	S5768_139_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													49.06	50	50	50					45.04	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	140	0		29	10	S5768_140_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	140	0		29	10	S5768_140_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													45.43	50	50	50					40.17	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	141	0		29	10	S5768_141_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	142	0		29	10	S5768_142_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													43.45	50	50	50					37.64	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	142	0		29	10	S5768_142_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	142	0		29	10	S5768_142_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	143	0		29	10	S5768_143_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	143	0		29	10	S5768_143_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													38.67	50	50	50					34.10	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	144	0		29	10	S5768_144_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	144	0		29	10	S5768_144_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													43.97	50	50	50					38.96	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	145	0		29	10	S5768_145_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													48.08	50	50	50					43.77	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	145	0		29	10	S5768_145_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	146	0		29	10	S5768_146_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													40.59	50	50	50					34.42	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	146	0		29	10	S5768_146_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	147	0		29	10	S5768_147_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	147	0		29	10	S5768_147_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													46.75	50	50	50					42.40	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	148	0		29	10	S5768_148_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	148	0		29	10	S5768_148_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													45.56	50	50	50					42.14	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	149	0		29	10	S5768_149_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													42.00	50	50	50					37.80	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	149	0		29	10	S5768_149_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													49.22	50	50	50					45.74	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	150	0		29	10	S5768_150_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	150	0		29	10	S5768_150_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	151	0		29	10	S5768_151_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	151	0		29	10	S5768_151_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													43.76	50	50	50					41.10	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													41.60	50	50	50					38.73	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	152	0		29	10	S5768_152_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	152	0		29	10	S5768_152_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	153	0		29	10	S5768_153_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	153	0		29	10	S5768_153_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													40.98	50	50	50					37.28	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	154	0		29	10	S5768_154_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	154	0		29	10	S5768_154_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													41.81	50	50	50					38.17	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	155	0		29	10	S5768_155_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	155	0		29	10	S5768_155_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													48.30	50	50	50					45.65	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	164	0		29	10	S5768_164_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	164	0		29	10	S5768_164_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	164	0		29	10	S5768_164_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	164	0		29	10	S5768_164_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													48.74	50	50	50					46.53	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	164	0		29	10	S5768_164_0	2	3	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	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												
S5768	164	0		29	10	S5768_164_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	164	0		29	10	S5768_164_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	164	0		29	10	S5768_164_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													76.96	50	50	50					74.31	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	165	0		29	10	S5768_165_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	165	0		29	10	S5768_165_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	165	0		29	10	S5768_165_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	165	0		29	10	S5768_165_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													40.91	50	50	50					39.65	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	165	0		29	10	S5768_165_0	2	3	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	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												
S5768	165	0		29	10	S5768_165_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	165	0		29	10	S5768_165_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	165	0		29	10	S5768_165_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													63.40	50	50	50					62.12	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	166	0		29	10	S5768_166_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	166	0		29	10	S5768_166_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	166	0		29	10	S5768_166_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													60.00	50	50	50					58.55	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	166	0		29	10	S5768_166_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	166	0		29	10	S5768_166_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	166	0		29	10	S5768_166_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	166	0		29	10	S5768_166_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													39.37	50	50	50					38.24	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	166	0		29	10	S5768_166_0	2	3	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	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												
S5768	167	0		29	10	S5768_167_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	167	0		29	10	S5768_167_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	167	0		29	10	S5768_167_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	167	0		29	10	S5768_167_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	167	0		29	10	S5768_167_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													38.46	50	50	50					36.78	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	167	0		29	10	S5768_167_0	2	3	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	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												
S5768	167	0		29	10	S5768_167_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	167	0		29	10	S5768_167_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													64.34	50	50	50					61.67	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	168	0		29	10	S5768_168_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	168	0		29	10	S5768_168_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	168	0		29	10	S5768_168_0	2	3	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	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												
S5768	168	0		29	10	S5768_168_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													40.82	50	50	50					39.21	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	168	0		29	10	S5768_168_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	168	0		29	10	S5768_168_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	168	0		29	10	S5768_168_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	168	0		29	10	S5768_168_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													65.76	50	50	50					63.81	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	169	0		29	10	S5768_169_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	169	0		29	10	S5768_169_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	169	0		29	10	S5768_169_0	2	3	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	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												
S5768	169	0		29	10	S5768_169_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													60.98	50	50	50					59.56	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	169	0		29	10	S5768_169_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	169	0		29	10	S5768_169_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	169	0		29	10	S5768_169_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	169	0		29	10	S5768_169_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													37.22	50	50	50					36.00	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	170	0		29	10	S5768_170_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													55.34	50	50	50					54.58	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	170	0		29	10	S5768_170_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	170	0		29	10	S5768_170_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	170	0		29	10	S5768_170_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	170	0		29	10	S5768_170_0	2	3	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	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												
S5768	170	0		29	10	S5768_170_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	170	0		29	10	S5768_170_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													34.19	50	50	50					33.30	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	170	0		29	10	S5768_170_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	171	0		29	10	S5768_171_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	171	0		29	10	S5768_171_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	171	0		29	10	S5768_171_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	171	0		29	10	S5768_171_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													41.81	50	50	50					39.83	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	171	0		29	10	S5768_171_0	2	3	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	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												
S5768	171	0		29	10	S5768_171_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	171	0		29	10	S5768_171_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	171	0		29	10	S5768_171_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													67.19	50	50	50					64.35	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	172	0		29	10	S5768_172_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	172	0		29	10	S5768_172_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	172	0		29	10	S5768_172_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													65.40	50	50	50					68.43	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	172	0		29	10	S5768_172_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	172	0		29	10	S5768_172_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	172	0		29	10	S5768_172_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	172	0		29	10	S5768_172_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													42.18	50	50	50					42.60	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	172	0		29	10	S5768_172_0	2	3	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	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												
S5768	173	0		29	10	S5768_173_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	173	0		29	10	S5768_173_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	173	0		29	10	S5768_173_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	173	0		29	10	S5768_173_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	173	0		29	10	S5768_173_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													41.09	50	50	50					40.36	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	173	0		29	10	S5768_173_0	2	3	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	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												
S5768	173	0		29	10	S5768_173_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	173	0		29	10	S5768_173_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													67.12	50	50	50					66.47	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	174	0		29	10	S5768_174_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	174	0		29	10	S5768_174_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													71.82	50	50	50					69.83	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	174	0		29	10	S5768_174_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	174	0		29	10	S5768_174_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	174	0		29	10	S5768_174_0	2	3	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	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												
S5768	174	0		29	10	S5768_174_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													47.18	50	50	50					45.29	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	174	0		29	10	S5768_174_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	174	0		29	10	S5768_174_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	175	0		29	10	S5768_175_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	175	0		29	10	S5768_175_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	175	0		29	10	S5768_175_0	2	3	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	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												
S5768	175	0		29	10	S5768_175_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													38.17	50	50	50					37.41	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	175	0		29	10	S5768_175_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	175	0		29	10	S5768_175_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	175	0		29	10	S5768_175_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													60.49	50	50	50					60.83	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	175	0		29	10	S5768_175_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	176	0		29	10	S5768_176_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													38.24	50	50	50					37.18	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	176	0		29	10	S5768_176_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													61.54	50	50	50					60.65	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	176	0		29	10	S5768_176_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	176	0		29	10	S5768_176_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	176	0		29	10	S5768_176_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	176	0		29	10	S5768_176_0	2	3	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	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												
S5768	176	0		29	10	S5768_176_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	176	0		29	10	S5768_176_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	177	0		29	10	S5768_177_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	177	0		29	10	S5768_177_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	177	0		29	10	S5768_177_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													37.00	50	50	50					36.25	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	177	0		29	10	S5768_177_0	2	3	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	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												
S5768	177	0		29	10	S5768_177_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	177	0		29	10	S5768_177_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	177	0		29	10	S5768_177_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													59.76	50	50	50					58.64	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	177	0		29	10	S5768_177_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	178	0		29	10	S5768_178_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													58.05	50	50	50					56.60	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	178	0		29	10	S5768_178_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	178	0		29	10	S5768_178_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	178	0		29	10	S5768_178_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	178	0		29	10	S5768_178_0	2	3	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	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												
S5768	178	0		29	10	S5768_178_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	178	0		29	10	S5768_178_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	178	0		29	10	S5768_178_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													36.61	50	50	50					35.03	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	179	0		29	10	S5768_179_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													39.93	50	50	50					38.37	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	179	0		29	10	S5768_179_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	179	0		29	10	S5768_179_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													63.06	50	50	50					61.08	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	179	0		29	10	S5768_179_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	179	0		29	10	S5768_179_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	179	0		29	10	S5768_179_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	179	0		29	10	S5768_179_0	2	3	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	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												
S5768	179	0		29	10	S5768_179_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	180	0		29	10	S5768_180_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	180	0		29	10	S5768_180_0	2	3	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	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												
S5768	180	0		29	10	S5768_180_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													43.24	50	50	50					40.82	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	180	0		29	10	S5768_180_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	180	0		29	10	S5768_180_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	180	0		29	10	S5768_180_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	180	0		29	10	S5768_180_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													70.72	50	50	50					66.79	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	180	0		29	10	S5768_180_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	181	0		29	10	S5768_181_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	181	0		29	10	S5768_181_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	181	0		29	10	S5768_181_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	181	0		29	10	S5768_181_0	2	3	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	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												
S5768	181	0		29	10	S5768_181_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													47.56	50	50	50					47.40	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	181	0		29	10	S5768_181_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	181	0		29	10	S5768_181_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	181	0		29	10	S5768_181_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													72.64	50	50	50					73.40	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	182	0		29	10	S5768_182_0	2	3	Preferred Brand	3	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	182	0		29	10	S5768_182_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	182	0		29	10	S5768_182_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	182	0		29	10	S5768_182_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													68.77	50	50	50					62.07	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	182	0		29	10	S5768_182_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	182	0		29	10	S5768_182_0	2	3	Preferred Brand	1	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	182	0		29	10	S5768_182_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													121.91	50	50	50					108.27	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	182	0		29	10	S5768_182_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	183	0		29	10	S5768_183_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	183	0		29	10	S5768_183_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													108.08	50	50	50					103.40	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	183	0		29	10	S5768_183_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	183	0		29	10	S5768_183_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	183	0		29	10	S5768_183_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													67.01	50	50	50					64.25	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	183	0		29	10	S5768_183_0	2	3	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	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												
S5768	183	0		29	10	S5768_183_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	183	0		29	10	S5768_183_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	184	0		29	10	S5768_184_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	184	0		29	10	S5768_184_0	2	3	Preferred Brand	1	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	184	0		29	10	S5768_184_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													38.20	50	50	50					37.61	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	184	0		29	10	S5768_184_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	184	0		29	10	S5768_184_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	184	0		29	10	S5768_184_0	2	3	Preferred Brand	3	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	184	0		29	10	S5768_184_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													60.64	50	50	50					61.16	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	184	0		29	10	S5768_184_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	185	0		29	10	S5768_185_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	185	0		29	10	S5768_185_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	185	0		29	10	S5768_185_0	2	3	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	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												
S5768	185	0		29	10	S5768_185_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													32.21	50	50	50					29.87	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	185	0		29	10	S5768_185_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	185	0		29	10	S5768_185_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	185	0		29	10	S5768_185_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													54.27	50	50	50					50.74	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	185	0		29	10	S5768_185_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	186	0		29	10	S5768_186_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													41.41	50	50	50					40.46	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	186	0		29	10	S5768_186_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	186	0		29	10	S5768_186_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	186	0		29	10	S5768_186_0	2	3	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	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												
S5768	186	0		29	10	S5768_186_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	186	0		29	10	S5768_186_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	186	0		29	10	S5768_186_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	186	0		29	10	S5768_186_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													68.01	50	50	50					67.59	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	187	0		29	10	S5768_187_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	187	0		29	10	S5768_187_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	187	0		29	10	S5768_187_0	2	3	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	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												
S5768	187	0		29	10	S5768_187_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													50.09	50	50	50					50.06	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	187	0		29	10	S5768_187_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	187	0		29	10	S5768_187_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	187	0		29	10	S5768_187_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	187	0		29	10	S5768_187_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													77.18	50	50	50					78.27	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	188	0		29	10	S5768_188_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	188	0		29	10	S5768_188_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	188	0		29	10	S5768_188_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													69.04	50	50	50					69.06	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	188	0		29	10	S5768_188_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	188	0		29	10	S5768_188_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	188	0		29	10	S5768_188_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	188	0		29	10	S5768_188_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													43.58	50	50	50					42.93	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	188	0		29	10	S5768_188_0	2	3	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	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												
S5768	189	0		29	10	S5768_189_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	189	0		29	10	S5768_189_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	189	0		29	10	S5768_189_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	189	0		29	10	S5768_189_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	189	0		29	10	S5768_189_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													40.90	50	50	50					39.73	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	189	0		29	10	S5768_189_0	2	3	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	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												
S5768	189	0		29	10	S5768_189_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	189	0		29	10	S5768_189_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													63.86	50	50	50					62.55	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	190	0		29	10	S5768_190_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	190	0		29	10	S5768_190_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	190	0		29	10	S5768_190_0	2	3	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	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												
S5768	190	0		29	10	S5768_190_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													75.11	50	50	50					62.48	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	190	0		29	10	S5768_190_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	190	0		29	10	S5768_190_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	190	0		29	10	S5768_190_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	190	0		29	10	S5768_190_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													48.08	50	50	50					39.38	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	191	0		29	10	S5768_191_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	191	0		29	10	S5768_191_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													62.88	50	50	50					61.71	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	191	0		29	10	S5768_191_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	191	0		29	10	S5768_191_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	191	0		29	10	S5768_191_0	2	3	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	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												
S5768	191	0		29	10	S5768_191_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													37.34	50	50	50					36.60	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	191	0		29	10	S5768_191_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	191	0		29	10	S5768_191_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	192	0		29	10	S5768_192_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	192	0		29	10	S5768_192_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	192	0		29	10	S5768_192_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	192	0		29	10	S5768_192_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													37.46	50	50	50					36.54	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	192	0		29	10	S5768_192_0	2	3	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	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												
S5768	192	0		29	10	S5768_192_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	192	0		29	10	S5768_192_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	192	0		29	10	S5768_192_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													61.99	50	50	50					61.30	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	193	0		29	10	S5768_193_0	2	3	Preferred Brand	1	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	193	0		29	10	S5768_193_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	193	0		29	10	S5768_193_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	193	0		29	10	S5768_193_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													39.99	50	50	50					39.01	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	193	0		29	10	S5768_193_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													65.49	50	50	50					64.93	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	193	0		29	10	S5768_193_0	2	3	Preferred Brand	3	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	193	0		29	10	S5768_193_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	193	0		29	10	S5768_193_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	194	0		29	10	S5768_194_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	194	0		29	10	S5768_194_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	194	0		29	10	S5768_194_0	2	3	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	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												
S5768	194	0		29	10	S5768_194_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													74.33	50	50	50					73.99	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	194	0		29	10	S5768_194_0	2	3	Preferred Brand	3	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	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										2	1	
S5768	194	0		29	10	S5768_194_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	194	0		29	10	S5768_194_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	194	0		29	10	S5768_194_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													46.94	50	50	50					46.45	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	195	0		29	10	S5768_195_0	3	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													74.82	50	50	50					70.52	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	195	0		29	10	S5768_195_0	3	3	Preferred Brand	3	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	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										2	1	
S5768	195	0		29	10	S5768_195_0	3	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	195	0		29	10	S5768_195_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	195	0		29	10	S5768_195_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													43.02	50	50	50					41.18	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	195	0		29	10	S5768_195_0	3	3	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	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												
S5768	195	0		29	10	S5768_195_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	195	0		29	10	S5768_195_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	196	0		29	10	S5768_196_0	2	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	33							1.00	33							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	196	0		29	10	S5768_196_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													39.54	50	50	50					38.48	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	196	0		29	10	S5768_196_0	2	3	Preferred Brand	1	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	196	0		29	10	S5768_196_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	196	0		29	10	S5768_196_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00																			4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	196	0		29	10	S5768_196_0	2	3	Preferred Brand	3	4	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	196	0		29	10	S5768_196_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													60.71	50	50	50					61.10	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	196	0		29	10	S5768_196_0	2	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													54.74	50	50	50					53.77	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	197	0		29	10	S5768_197_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5768	197	0		29	10	S5768_197_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00					0.10	3.00	6.00	9.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									1.16	35.00	70.00	105.00					1.16	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												
S5768	198	0		29	10	S5768_198_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31													55.16	50	50	50					55.29	50	50	50					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	1	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31													1.00	25							1.00	25							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31									0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00					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												
S5795	002	0		29	10	S5795_002_0	2	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		4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	2	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.40	12.00		30.00																					.40	12.00		30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	2	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	2	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	2	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31						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	2	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.06	2.00		4.00																					.06	2.00		4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5795	002	0		29	10	S5795_002_0	2	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.40	12.00		30.00																					.40	12.00		30.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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									.33	10.00		25.00					.13	4.00		10.00					.13	4.00		10.00																		10.00				.12	4.00		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									1.10	33.00		82.50					.50	15.00		37.50					.50	15.00		37.50																		33.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	2	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		112.50					1.33	40.00		100.00					1.33	40.00		100.00																		45.00				1.29	40.00		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													37.04	33		33					31.96	30		30					30		30																	33				30	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													522.10	25		25					335.51	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	1	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	5.00		15.00															24.00							5.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													665.00	33		33					665.00	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	1	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					2.66	80.00		240.00															285.00							235.00				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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.16	35.00		105.00															135.00							100.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	3	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	3	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	3	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.44	36	36	36					34.58	36	36	36												36	36	36					36	36	36				36			36	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	3	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.30	37	37	37					36.69	37	37	37												37	37	37					37	37	37				37			37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													49.13	38	38	38					48.85	38	38	38												38	38	38					38	38	38				38			38	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													45.34	38	38	38					40.74	38	38	38												38	38	38					38	38	38				38			38	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													44.61	37	37	37					41.34	37	37	37												37	37	37					37	37	37				37			37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													40.87	37	37	37					38.57	37	37	37												37	37	37					37	37	37				37			37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.31	37	37	37					36.81	37	37	37												37	37	37					37	37	37				37			37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													40.90	38	38	38					38.08	38	38	38												38	38	38					38	38	38				38			38	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	1	4	Non-Preferred Brand	1	3	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					36.47	39	39	39																					39	39	39																		39			39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	1	5	Specialty Tier	1	3	010010	1	1	010		10	010		1	30							30							10	31					1.00	25																							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	1	3	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	123.00																			41.00			1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	1	2	Non-Preferred Generic	1	3	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.23	7.00	14.00	21.00																					0.23	7.00	14.00	21.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	1	1	Preferred Generic	1	3	001000	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												
S5810	044	0		29	10	S5810_044_0	1	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	1	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.56	38	38	38					35.57	38	38	38												38	38	38					38	38	38				38			38	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	1	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	2	5	Specialty Tier	1	3	010010	1	1	010		10	010		1	30							30							10	31					1.00	26																							26																				26			26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	2	4	Non-Preferred Brand	1	3	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					46.09	39	39	39																					39	39	39																		39			39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	2	3	Preferred Brand	1	3	010001	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	1.33	40.00	80.00	120.00																					1.33	40.00	80.00	120.00																			40.00			1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	2	1	Preferred Generic	1	3	001000	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												
S5810	045	0		29	10	S5810_045_0	2	2	Non-Preferred Generic	1	3	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.23	7.00	14.00	21.00																					0.23	7.00	14.00	21.00																			7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													33.12	36	36	36					30.64	36	36	36												36	36	36					36	36	36				36			36	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.70	35	35	35					35.84	35	35	35												35	35	35					35	35	35				35			35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.17	36	36	36					36.43	36	36	36												36	36	36					36	36	36				36			36	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													40.29	37	37	37					38.17	37	37	37												37	37	37					37	37	37				37			37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													42.13	37	37	37					38.02	37	37	37												37	37	37					37	37	37				37			37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													40.37	38	38	38					36.95	38	38	38												38	38	38					38	38	38				38			38	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													40.76	36	36	36					36.59	36	36	36												36	36	36					36	36	36				36			36	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													34.22	35	35	35					31.60	35	35	35												35	35	35					35	35	35				35			35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													34.75	39	39	39					32.31	39	39	39												39	39	39					39	39	39				39			39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													36.99	37	37	37					34.20	37	37	37												37	37	37					37	37	37				37			37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													42.75	39	39	39					39.53	39	39	39												39	39	39					39	39	39				39			39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													34.80	37	37	37					30.84	37	37	37												37	37	37					37	37	37				37			37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													41.63	36	36	36					37.86	36	36	36												36	36	36					36	36	36				36			36	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													40.52	36	36	36					37.17	36	36	36												36	36	36					36	36	36				36			36	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													51.57	43	43	43					52.47	43	43	43												43	43	43					43	43	43				43			43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													44.41	36	36	36					43.26	36	36	36												36	36	36					36	36	36				36			36	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	2	4	Non-Preferred Brand	1	3	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					36.65	34	34	34																					34	34	34																		34			34	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	2	5	Specialty Tier	1	3	010010	1	1	010		10	010		1	30							30							10	31					1.00	25																							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	2	1	Preferred Generic	1	3	001000	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												
S5810	062	0		29	10	S5810_062_0	2	2	Non-Preferred Generic	1	3	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.26	8.00	16.00	24.00																					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												
S5810	062	0		29	10	S5810_062_0	2	3	Preferred Brand	1	3	010001	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	1.16	35.00	70.00	105.00																					1.16	35.00	70.00	105.00																			35.00			1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	2	1	Preferred Generic	1	3	001000	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												
S5810	063	0		29	10	S5810_063_0	2	5	Specialty Tier	1	3	010010	1	1	010		10	010		1	30							30							10	31					1.00	25																							25																				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	2	2	Non-Preferred Generic	1	3	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.26	8.00	16.00	24.00																					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												
S5810	063	0		29	10	S5810_063_0	2	3	Preferred Brand	1	3	010001	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	1.16	35.00	70.00	105.00																					1.16	35.00	70.00	105.00																			35.00			1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	2	4	Non-Preferred Brand	1	3	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					38.86	37	37	37																					37	37	37																		37			37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	2	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	2	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	2	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	2	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													36.54	35	35	35					35.04	35	35	35												35	35	35					35	35	35				35			35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	1	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													41.14	36	36	36					38.03	36	36	36												36	36	36					36	36	36				36			36	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	1	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	1	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	1	5	Specialty Tier	1	3	010010	1	1	010		10	010		1	30							30							10	31					1.00	26																							26																				26			26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	1	4	Non-Preferred Brand	1	3	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31					43.11	38	38	38																					38	38	38																		38			38	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	1	3	Preferred Brand	1	3	010001	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	1.16	35.00	70.00	105.00																					1.16	35.00	70.00	105.00																			35.00			1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	1	2	Non-Preferred Generic	1	3	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.26	8.00	16.00	24.00																					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												
S5810	066	0		29	10	S5810_066_0	1	1	Preferred Generic	1	3	001000	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												
S5810	067	0		29	10	S5810_067_0	1	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													49.32	39	39	39					46.29	39	39	39												39	39	39					39	39	39				39			39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	1	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	1	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	1	5	Specialty Tier	1	2	010010	1	1		010	10		010	1				30							30				10	31													1.00	25							1.00	25														25							25						25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													46.01	42	42	42					42.73	42	42	42												42	42	42					42	42	42				42			42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	1	3	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	1	2	Non-Preferred Generic	1	2	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.16	5.00	10.00	15.00					0.10	3.00	6.00	9.00												0.16	5.00	10.00	15.00				0.10	3.00	6.00	9.00					5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	1	1	Preferred Generic	1	2	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												0.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00					2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	172	0		29	10	S5810_172_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	172	0		29	10	S5810_172_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													42.59	50	50	50					41.01	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	172	0		29	10	S5810_172_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	172	0		29	10	S5810_172_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													69.29	50	50	50					67.99	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	172	0		29	10	S5810_172_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	172	0		29	10	S5810_172_0	1	3	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	135.00												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												
S5810	172	0		29	10	S5810_172_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	172	0		29	10	S5810_172_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	174	0		29	10	S5810_174_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	174	0		29	10	S5810_174_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	174	0		29	10	S5810_174_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	174	0		29	10	S5810_174_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													76.14	50	50	50					71.37	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	174	0		29	10	S5810_174_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	174	0		29	10	S5810_174_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	174	0		29	10	S5810_174_0	1	3	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	135.00												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												
S5810	174	0		29	10	S5810_174_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													47.55	50	50	50					43.85	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	175	0		29	10	S5810_175_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	175	0		29	10	S5810_175_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	175	0		29	10	S5810_175_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	175	0		29	10	S5810_175_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													69.31	50	50	50					64.80	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	175	0		29	10	S5810_175_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	175	0		29	10	S5810_175_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	175	0		29	10	S5810_175_0	1	3	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	135.00												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												
S5810	175	0		29	10	S5810_175_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													41.87	50	50	50					38.37	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	176	0		29	10	S5810_176_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	176	0		29	10	S5810_176_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	176	0		29	10	S5810_176_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	176	0		29	10	S5810_176_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													63.13	50	50	50					59.72	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	176	0		29	10	S5810_176_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.55	50	50	50					36.77	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	176	0		29	10	S5810_176_0	1	3	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	135.00												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												
S5810	176	0		29	10	S5810_176_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	176	0		29	10	S5810_176_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	177	0		29	10	S5810_177_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	177	0		29	10	S5810_177_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	177	0		29	10	S5810_177_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	177	0		29	10	S5810_177_0	1	3	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	135.00												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												
S5810	177	0		29	10	S5810_177_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													34.73	50	50	50					31.81	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	177	0		29	10	S5810_177_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	177	0		29	10	S5810_177_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	177	0		29	10	S5810_177_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													58.43	50	50	50					54.90	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	178	0		29	10	S5810_178_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	178	0		29	10	S5810_178_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	178	0		29	10	S5810_178_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													61.44	50	50	50					57.29	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	178	0		29	10	S5810_178_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	178	0		29	10	S5810_178_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	178	0		29	10	S5810_178_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	178	0		29	10	S5810_178_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.70	50	50	50					34.61	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	178	0		29	10	S5810_178_0	1	3	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	135.00												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												
S5810	179	0		29	10	S5810_179_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	179	0		29	10	S5810_179_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	179	0		29	10	S5810_179_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	179	0		29	10	S5810_179_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	179	0		29	10	S5810_179_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													35.59	50	50	50					31.28	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	179	0		29	10	S5810_179_0	1	3	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	135.00												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												
S5810	179	0		29	10	S5810_179_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	179	0		29	10	S5810_179_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													59.27	50	50	50					53.32	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	180	0		29	10	S5810_180_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	180	0		29	10	S5810_180_0	1	3	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	135.00												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												
S5810	180	0		29	10	S5810_180_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	180	0		29	10	S5810_180_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	180	0		29	10	S5810_180_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													31.62	50	50	50					28.54	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	180	0		29	10	S5810_180_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	180	0		29	10	S5810_180_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	180	0		29	10	S5810_180_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													53.45	50	50	50					49.34	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	182	0		29	10	S5810_182_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													31.37	50	50	50					28.73	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	182	0		29	10	S5810_182_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	182	0		29	10	S5810_182_0	1	3	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	135.00												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												
S5810	182	0		29	10	S5810_182_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													51.70	50	50	50					48.15	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	182	0		29	10	S5810_182_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	182	0		29	10	S5810_182_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	182	0		29	10	S5810_182_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	182	0		29	10	S5810_182_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	183	0		29	10	S5810_183_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													58.99	50	50	50					53.92	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	183	0		29	10	S5810_183_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	183	0		29	10	S5810_183_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	183	0		29	10	S5810_183_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	183	0		29	10	S5810_183_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													33.73	50	50	50					29.82	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	183	0		29	10	S5810_183_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	183	0		29	10	S5810_183_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	183	0		29	10	S5810_183_0	1	3	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	135.00												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												
S5810	184	0		29	10	S5810_184_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	184	0		29	10	S5810_184_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	184	0		29	10	S5810_184_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													61.22	50	50	50					57.09	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	184	0		29	10	S5810_184_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.37	50	50	50					34.01	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	184	0		29	10	S5810_184_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	184	0		29	10	S5810_184_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	184	0		29	10	S5810_184_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	184	0		29	10	S5810_184_0	1	3	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	135.00												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												
S5810	185	0		29	10	S5810_185_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	185	0		29	10	S5810_185_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													60.54	50	50	50					56.37	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	185	0		29	10	S5810_185_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	185	0		29	10	S5810_185_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	185	0		29	10	S5810_185_0	1	3	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	135.00												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												
S5810	185	0		29	10	S5810_185_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													35.63	50	50	50					32.36	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	185	0		29	10	S5810_185_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	185	0		29	10	S5810_185_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	186	0		29	10	S5810_186_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	186	0		29	10	S5810_186_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	186	0		29	10	S5810_186_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	186	0		29	10	S5810_186_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													35.96	50	50	50					32.68	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	186	0		29	10	S5810_186_0	1	3	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	135.00												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												
S5810	186	0		29	10	S5810_186_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	186	0		29	10	S5810_186_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	186	0		29	10	S5810_186_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													60.44	50	50	50					55.70	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	187	0		29	10	S5810_187_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	187	0		29	10	S5810_187_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	187	0		29	10	S5810_187_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	187	0		29	10	S5810_187_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													34.98	50	50	50					30.95	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	187	0		29	10	S5810_187_0	1	3	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	135.00												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												
S5810	187	0		29	10	S5810_187_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	187	0		29	10	S5810_187_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	187	0		29	10	S5810_187_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													59.28	50	50	50					53.71	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	188	0		29	10	S5810_188_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	188	0		29	10	S5810_188_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	188	0		29	10	S5810_188_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													57.65	50	50	50					52.59	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	188	0		29	10	S5810_188_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	188	0		29	10	S5810_188_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	188	0		29	10	S5810_188_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	188	0		29	10	S5810_188_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													35.05	50	50	50					31.23	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	188	0		29	10	S5810_188_0	1	3	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	135.00												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												
S5810	189	0		29	10	S5810_189_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	189	0		29	10	S5810_189_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	189	0		29	10	S5810_189_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	189	0		29	10	S5810_189_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	189	0		29	10	S5810_189_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													33.42	50	50	50					28.83	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	189	0		29	10	S5810_189_0	1	3	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	135.00												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												
S5810	189	0		29	10	S5810_189_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	189	0		29	10	S5810_189_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													57.00	50	50	50					50.40	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	190	0		29	10	S5810_190_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	190	0		29	10	S5810_190_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	190	0		29	10	S5810_190_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	190	0		29	10	S5810_190_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													31.95	50	50	50					29.52	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	190	0		29	10	S5810_190_0	1	3	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	135.00												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												
S5810	190	0		29	10	S5810_190_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	190	0		29	10	S5810_190_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	190	0		29	10	S5810_190_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													53.96	50	50	50					50.53	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	191	0		29	10	S5810_191_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	191	0		29	10	S5810_191_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	191	0		29	10	S5810_191_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	191	0		29	10	S5810_191_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.85	50	50	50					34.21	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	191	0		29	10	S5810_191_0	1	3	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	135.00												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												
S5810	191	0		29	10	S5810_191_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	191	0		29	10	S5810_191_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	191	0		29	10	S5810_191_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													60.94	50	50	50					55.53	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	192	0		29	10	S5810_192_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	192	0		29	10	S5810_192_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	192	0		29	10	S5810_192_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													61.63	50	50	50					57.63	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	192	0		29	10	S5810_192_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	192	0		29	10	S5810_192_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	192	0		29	10	S5810_192_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	192	0		29	10	S5810_192_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.78	50	50	50					34.82	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	192	0		29	10	S5810_192_0	1	3	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	135.00												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												
S5810	193	0		29	10	S5810_193_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	193	0		29	10	S5810_193_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	193	0		29	10	S5810_193_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	193	0		29	10	S5810_193_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	193	0		29	10	S5810_193_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													48.27	50	50	50					45.84	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	193	0		29	10	S5810_193_0	1	3	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	135.00												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												
S5810	193	0		29	10	S5810_193_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	193	0		29	10	S5810_193_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													73.50	50	50	50					71.78	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	194	0		29	10	S5810_194_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	194	0		29	10	S5810_194_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	194	0		29	10	S5810_194_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													60.31	50	50	50					56.08	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	194	0		29	10	S5810_194_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	194	0		29	10	S5810_194_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	194	0		29	10	S5810_194_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	194	0		29	10	S5810_194_0	1	3	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	135.00												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												
S5810	194	0		29	10	S5810_194_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.57	50	50	50					34.10	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	195	0		29	10	S5810_195_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	195	0		29	10	S5810_195_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	195	0		29	10	S5810_195_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	195	0		29	10	S5810_195_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													37.54	50	50	50					33.93	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	195	0		29	10	S5810_195_0	1	3	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	135.00												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												
S5810	195	0		29	10	S5810_195_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	195	0		29	10	S5810_195_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	195	0		29	10	S5810_195_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													63.43	50	50	50					58.45	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	197	0		29	10	S5810_197_0	1	3	Preferred Brand	3	4	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				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										2	1	
S5810	197	0		29	10	S5810_197_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	197	0		29	10	S5810_197_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	197	0		29	10	S5810_197_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													43.93	50	50	50					39.61	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	197	0		29	10	S5810_197_0	1	3	Preferred Brand	1	4	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				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												
S5810	197	0		29	10	S5810_197_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	197	0		29	10	S5810_197_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	197	0		29	10	S5810_197_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													74.68	50	50	50					68.43	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	198	0		29	10	S5810_198_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	198	0		29	10	S5810_198_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	198	0		29	10	S5810_198_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													68.25	50	50	50					61.97	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	198	0		29	10	S5810_198_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	198	0		29	10	S5810_198_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	198	0		29	10	S5810_198_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	198	0		29	10	S5810_198_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.74	50	50	50					36.03	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	198	0		29	10	S5810_198_0	1	3	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	135.00												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												
S5810	199	0		29	10	S5810_199_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	199	0		29	10	S5810_199_0	1	3	Preferred Brand	3	4	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				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										2	1	
S5810	199	0		29	10	S5810_199_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	199	0		29	10	S5810_199_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	199	0		29	10	S5810_199_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													35.07	50	50	50					32.18	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	199	0		29	10	S5810_199_0	1	3	Preferred Brand	1	4	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				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												
S5810	199	0		29	10	S5810_199_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	199	0		29	10	S5810_199_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													58.80	50	50	50					55.60	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	200	0		29	10	S5810_200_0	1	3	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	135.00												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												
S5810	200	0		29	10	S5810_200_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	200	0		29	10	S5810_200_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	200	0		29	10	S5810_200_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													65.25	50	50	50					58.04	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	200	0		29	10	S5810_200_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	200	0		29	10	S5810_200_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	200	0		29	10	S5810_200_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	200	0		29	10	S5810_200_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.18	50	50	50					33.86	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	201	0		29	10	S5810_201_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	201	0		29	10	S5810_201_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	201	0		29	10	S5810_201_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													60.50	50	50	50					56.23	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	201	0		29	10	S5810_201_0	1	3	Preferred Brand	3	4	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				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										2	1	
S5810	201	0		29	10	S5810_201_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	201	0		29	10	S5810_201_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	201	0		29	10	S5810_201_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													36.83	50	50	50					33.60	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	201	0		29	10	S5810_201_0	1	3	Preferred Brand	1	4	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				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												
S5810	202	0		29	10	S5810_202_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													72.77	50	50	50					66.88	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	202	0		29	10	S5810_202_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	202	0		29	10	S5810_202_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	202	0		29	10	S5810_202_0	1	3	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	135.00												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												
S5810	202	0		29	10	S5810_202_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													44.28	50	50	50					39.32	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	202	0		29	10	S5810_202_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	202	0		29	10	S5810_202_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	202	0		29	10	S5810_202_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	204	0		29	10	S5810_204_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	204	0		29	10	S5810_204_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	204	0		29	10	S5810_204_0	1	3	Preferred Brand	3	4	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				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										2	1	
S5810	204	0		29	10	S5810_204_0	1	3	Preferred Brand	1	4	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				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												
S5810	204	0		29	10	S5810_204_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													71.22	50	50	50					65.79	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	204	0		29	10	S5810_204_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	204	0		29	10	S5810_204_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	204	0		29	10	S5810_204_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													42.62	50	50	50					36.99	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	239	0		29	10	S5810_239_0	1	3	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	135.00												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												
S5810	239	0		29	10	S5810_239_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	239	0		29	10	S5810_239_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	239	0		29	10	S5810_239_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													44.61	50	50	50					41.26	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	239	0		29	10	S5810_239_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	239	0		29	10	S5810_239_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	239	0		29	10	S5810_239_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	239	0		29	10	S5810_239_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													69.78	50	50	50					65.46	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	240	0		29	10	S5810_240_0	1	3	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	135.00												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												
S5810	240	0		29	10	S5810_240_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	240	0		29	10	S5810_240_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	240	0		29	10	S5810_240_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													39.38	50	50	50					35.33	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	240	0		29	10	S5810_240_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													61.83	50	50	50					56.89	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5810	240	0		29	10	S5810_240_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	240	0		29	10	S5810_240_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	240	0		29	10	S5810_240_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	241	0		29	10	S5810_241_0	1	1	Preferred Generic	1	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	241	0		29	10	S5810_241_0	1	2	Non-Preferred Generic	1	4	000100	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.23	7.00	14.00	21.00					0.10	3.00	6.00	9.00												0.23	7.00	14.00	21.00				0.10	3.00	6.00	9.00					7.00			0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	241	0		29	10	S5810_241_0	1	3	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	135.00												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												
S5810	241	0		29	10	S5810_241_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													33.19	50	50	50					29.96	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	241	0		29	10	S5810_241_0	1	5	Specialty Tier	1	4	010010	1	1		010	10		010	1				30							30				10	31													1.00	33							1.00	33														33							33						33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	241	0		29	10	S5810_241_0	1	1	Preferred Generic	3	4	001000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									0.13	4.00	8.00	12.00					0.00	0.00	0.00	0.00												0.13	4.00	8.00	12.00				0.00	0.00	0.00	0.00					4.00			0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5810	241	0		29	10	S5810_241_0	1	3	Preferred Brand	3	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	135.00												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										2	1	
S5810	241	0		29	10	S5810_241_0	1	4	Non-Preferred Brand	3	4	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													59.41	50	50	50					53.99	50	50	50												50	50	50					50	50	50				50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5820	001	0		29	10	S5820_001_0	1	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					2.83	85.00		255.00															285.00							250.00				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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.23	37.00		111.00															135.00							106.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.06	2.00		6.00															9.00							0.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.33	10.00		30.00					.16	5.00		15.00															30.00							5.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													609.00	33		33					609.00	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	1	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					2.50	75.00		225.00															285.00							220.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.30	9.00		27.00					.16	5.00		15.00															27.00							5.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.10	3.00		9.00															15.00							0.00				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	1	5	Specialty Tier	1	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												
S5820	003	0		29	10	S5820_003_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	1	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	5.00		15.00															24.00							5.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.16	35.00		105.00															135.00							100.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	1	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					2.66	80.00		240.00															285.00							235.00				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	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													681.00	33		33					681.00	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	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.10	3.00		9.00															15.00							0.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.30	9.00		27.00					.16	5.00		15.00															27.00							5.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.26	38.00		114.00															135.00							109.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	1	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					2.83	85.00		255.00															285.00							250.00				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	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													613.00	33		33					613.00	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	1	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	5.00		15.00															24.00							5.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													665.00	33		33					665.00	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	1	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					2.66	80.00		240.00															285.00							235.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	1	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					2.66	80.00		240.00															255.00							235.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.33	10.00		30.00					.16	5.00		15.00															30.00							5.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													613.00	33		33					613.00	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	1	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					2.66	80.00		240.00															285.00							235.00				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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.16	35.00		105.00															135.00							100.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	1	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	5.00		15.00															24.00							5.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													672.00	33		33					672.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													747.00	33		33					747.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.30	9.00		27.00					.16	5.00		15.00															27.00							5.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.10	3.00		9.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	1	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					2.50	75.00		225.00															285.00							220.00				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	1	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					2.66	80.00		240.00															285.00							235.00				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	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													673.00	33		33					673.00	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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.26	8.00		24.00					.13	4.00		12.00															24.00							4.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													679.00	33		33					679.00	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	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.13	4.00		12.00															15.00							0.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	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					2.66	80.00		240.00															285.00							235.00				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	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.30	9.00		27.00					.20	6.00		18.00															27.00							6.00				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	1	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												
S5820	011	0		29	10	S5820_011_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.03	1.00		3.00															15.00							0.00				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	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.10	3.00		9.00															21.00							3.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.26	38.00		114.00															135.00							109.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	1	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					2.83	85.00		255.00															285.00							250.00				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	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							0.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	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					2.83	85.00		255.00															285.00							250.00				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	1	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												
S5820	012	0		29	10	S5820_012_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.30	9.00		27.00					.13	4.00		12.00															27.00							4.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	1	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												
S5820	013	0		29	10	S5820_013_0	1	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	5.00		15.00															24.00							5.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	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					2.66	80.00		240.00															270.00							235.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.10	3.00		9.00															15.00							0.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													650.00	33		33					650.00	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	1	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					2.83	85.00		255.00															270.00							250.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.06	2.00		6.00															18.00							0.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.13	4.00		12.00															21.00							4.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	1	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					2.50	75.00		225.00															285.00							220.00				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	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													633.00	33		33					633.00	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	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.30	9.00		27.00					.23	7.00		21.00															27.00							7.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.16	5.00		15.00															21.00							0.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.23	37.00		111.00															135.00							106.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.10	3.00		9.00															18.00							0.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	1	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	5.00		15.00															24.00							5.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	1	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												
S5820	016	0		29	10	S5820_016_0	1	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					2.66	80.00		240.00															270.00							235.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.23	37.00		111.00															135.00							106.00				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	1	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					2.83	85.00		255.00															270.00							250.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													596.00	33		33					596.00	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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.43	43.00		129.00					1.23	37.00		111.00															129.00							106.00				43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.30	9.00		27.00					.16	5.00		15.00															27.00							5.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.10	3.00		9.00															18.00							0.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.03	1.00		3.00															15.00							0.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.30	9.00		27.00					.10	3.00		9.00															27.00							3.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	1	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					2.83	85.00		255.00															285.00							250.00				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	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													680.00	33		33					680.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.03	1.00		3.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.26	8.00		24.00					.10	3.00		9.00															24.00							3.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													707.00	33		33					707.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	1	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					2.66	80.00		240.00															270.00							235.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.26	38.00		114.00															135.00							109.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	1	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					2.83	85.00		255.00															270.00							250.00				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	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													630.00	33		33					630.00	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	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.03	1.00		3.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.06	2.00		6.00															18.00							2.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.10	3.00		9.00															15.00							0.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	1	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					2.83	85.00		255.00															270.00							250.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													669.00	33		33					669.00	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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.26	38.00		114.00															120.00							109.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	1	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	5.00		15.00															24.00							5.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													768.00	33		33					768.00	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	1	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					2.83	85.00		255.00															285.00							250.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.13	4.00		12.00															18.00							4.00				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	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	1	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	5.00		15.00															24.00							5.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													672.00	33		33					672.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	1	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					2.83	85.00		255.00															285.00							250.00				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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.26	8.00		24.00					.13	4.00		12.00															24.00							4.00				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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													599.00	33		33					599.00	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	1	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					2.83	85.00		255.00															285.00							250.00				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	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													550.00	33		33					550.00	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	1	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					2.83	85.00		255.00															285.00							250.00				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	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.30	9.00		27.00					.20	6.00		18.00															27.00							6.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.10	3.00		9.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	1	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					2.50	75.00		225.00															285.00							220.00				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	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													646.00	33		33					646.00	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	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.30	9.00		27.00					.16	5.00		15.00															27.00							5.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.10	3.00		9.00															18.00							0.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	1	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					2.66	80.00		240.00															285.00							235.00				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	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													661.00	33		33					661.00	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	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.30	9.00		27.00					.20	6.00		18.00															27.00							6.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.10	3.00		9.00															18.00							0.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.10	3.00		9.00															15.00							0.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.33	10.00		30.00					.16	5.00		15.00															30.00							5.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													720.00	33		33					720.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	1	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					2.83	85.00		255.00															285.00							250.00				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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	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					2.83	85.00		255.00															285.00							250.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	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												
S5820	029	0		29	10	S5820_029_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.16	5.00		15.00															21.00							5.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							0.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	1	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					2.83	85.00		255.00															285.00							250.00				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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.13	4.00		12.00															21.00							4.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							0.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													694.00	33		33					694.00	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	1	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					2.83	85.00		255.00															285.00							250.00				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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.26	8.00		24.00					.10	3.00		9.00															24.00							3.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							0.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													677.00	33		33					677.00	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	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.10	3.00		9.00															21.00							0.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.33	10.00		30.00					.16	5.00		15.00															30.00							5.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	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					2.50	75.00		225.00															285.00							220.00				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	1	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													699.00	33		33					699.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							0.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.26	8.00		24.00					.13	4.00		12.00															24.00							4.00				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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.33	40.00		120.00															135.00							115.00				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	1	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					2.83	85.00		255.00															285.00							250.00				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	1	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												
S5820	034	0		29	10	S5820_034_0	3	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	30		90				1			90				30		31	.06	2.00		6.00																								6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	3	3	Preferred Brand	1	2	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.00	30.00		90.00																								90.00																		30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	3	4	Non-Preferred Brand	1	2	100100	1	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		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	3	5	Specialty Tier	1	2	000010	1	1	110		01	100		1	30		90				1			90				30		31					498.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	3	2	Non-Preferred Generic	1	2	000100	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, Non-Preferred Brand, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	1	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																								270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	1	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	1	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	1	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	.20	6.00		18.00																								18.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	1	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				1			90				30		31					827.00	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	3	4	Non-Preferred Brand	1	2	100100	1	2	110		01	100		1	30		90				1			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												
S5820	036	0		29	10	S5820_036_0	3	3	Preferred Brand	1	2	000001	1	2	110		01	100		1	30		90				1			90				30		31	.86	26.00		78.00																								78.00																		26.00				.83	26.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	3	2	Non-Preferred Generic	1	2	000100	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, Non-Preferred Brand, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	3	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	30		90				1			90				30		31	.06	2.00		6.00																								6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	3	5	Specialty Tier	1	2	000010	1	1	110		01	100		1	30		90				1			90				30		31					447.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	1	1	Preferred Generic	1	3	001000	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.10	3.00		9.00															18.00							8.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	1	2	Non-Preferred Generic	1	3	000100	1	2		110	01		100	1				30		90	1						90	30		31									.26	8.00		24.00					.20	6.00		18.00															24.00							17.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	1	3	Preferred Brand	1	3	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.43	43.00		129.00					1.33	40.00		120.00															129.00							115.00				43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_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					2.66	80.00		240.00															255.00							235.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	1	5	Specialty Tier	1	3	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												
S5820	038	0		29	10	S5820_038_0	2	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	.20	6.00		18.00																								18.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	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	038	0		29	10	S5820_038_0	2	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	2	4	Non-Preferred Brand	1	3	100100	1	2	110		01	100		1	30		90				1			90				30		31	3.06	92.00		276.00																								276.00																		92.00				2.96	92.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				1			90				30		31					854.00	33		33																							33																	33				33	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	.06	2.00		6.00																								6.00																			2.00			.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	.44	15.00		45.00																								45.00																			15.00			.44	15.00		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					31.00	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					39.00	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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													65.00	50		50					55.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													70.00	50		50					59.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	002	0		29	10	S5884_002_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													75.00	50		50					63.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													71.00	50		50					57.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													66.00	50		50					54.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													70.00	50		50					59.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													67.00	50		50					57.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													72.00	50		50					62.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													69.00	50		50					58.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													70.00	50		50					59.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													65.00	50		50					55.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	021	0		29	10	S5884_021_0	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													67.00	50		50					56.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													71.00	50		50					60.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													68.00	50		50					57.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													72.00	50		50					62.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													73.00	50		50					61.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													66.00	50		50					55.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													70.00	50		50					58.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													70.00	50		50					59.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	071	0		29	10	S5884_071_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													68.00	50		50					56.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													68.00	50		50					57.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													69.00	50		50					59.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													66.00	50		50					56.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	077	0		29	10	S5884_077_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													68.00	50		50					57.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	077	0		29	10	S5884_077_0	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													67.00	50		50					56.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													66.00	50		50					56.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	085	0		29	10	S5884_085_0	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	085	0		29	10	S5884_085_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													70.00	50		50					60.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													69.00	50		50					59.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													73.00	50		50					61.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	089	0		29	10	S5884_089_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													67.00	50		50					56.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	092	0		29	10	S5884_092_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													78.00	50		50					65.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													81.00	50		50					70.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	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					0.23	7.00		21.00												0.40	12.00		36.00				0.23	7.00		0.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	2	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													71.00	50		50					59.00	44		44												50		50					44		44			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	2	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					0.10	3.00		9.00												0.23	7.00		21.00				0.10	3.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	2	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.50	45.00		135.00					1.40	42.00		126.00												1.50	45.00		135.00				1.40	42.00		116.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.16	95.00		285.00					3.13	94.00		282.00												3.16	95.00		285.00				3.13	94.00		272.00				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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													66.00	42		42					48.00	35		35												42		42					35		35			42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	25		25					19.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													62.00	36		36					54.00	35		35												36		36					35		35			36				36	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					19.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				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	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.03	1.00		3.00												0.06	2.00		6.00				0.03	1.00		0.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				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	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													71.00	41		41					50.00	35		35												41		41					35		35			41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.06	2.00		6.00												0.16	5.00		15.00				0.06	2.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	25		25					19.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													63.00	42		42					47.00	35		35												42		42					35		35			42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.06	2.00		6.00												0.16	5.00		15.00				0.06	2.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													57.00	40		40					40.00	35		35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													59.00	42		42					43.00	35		35												42		42					35		35			42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	25		25					16.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													68.00	43		43					47.00	35		35												43		43					35		35			43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	25		25					19.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					17.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													62.00	42		42					45.00	35		35												42		42					35		35			42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.20	6.00		18.00					0.06	2.00		6.00												0.20	6.00		18.00				0.06	2.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													69.00	43		43					48.00	35		35												43		43					35		35			43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.03	1.00		3.00												0.06	2.00		6.00				0.03	1.00		0.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													64.00	41		41					49.00	35		35												41		41					35		35			41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.03	1.00		3.00												0.06	2.00		6.00				0.03	1.00		0.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													62.00	40		40					49.00	35		35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	25		25					17.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													51.00	38		38					43.00	35		35												38		38					35		35			38				38	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.03	1.00		3.00												0.06	2.00		6.00				0.03	1.00		0.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.06	2.00		6.00												0.10	3.00		9.00				0.06	2.00		0.00				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	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	25		25					17.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													62.00	40		40					48.00	35		35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.20	6.00		18.00					0.06	2.00		6.00												0.20	6.00		18.00				0.06	2.00		0.00				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	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													60.00	38		38					49.00	35		35												38		38					35		35			38				38	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.06	2.00		6.00												0.10	3.00		9.00				0.06	2.00		0.00				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	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.03	1.00		3.00												0.06	2.00		6.00				0.03	1.00		0.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.03	1.00		3.00												0.06	2.00		6.00				0.03	1.00		0.00				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	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.06	2.00		6.00												0.10	3.00		9.00				0.06	2.00		0.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													69.00	36		36					61.00	35		35												36		36					35		35			36				36	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													26.00	25		25					20.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													67.00	39		39					55.00	35		35												39		39					35		35			39				39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	25		25					17.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.06	2.00		6.00												0.10	3.00		9.00				0.06	2.00		0.00				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	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.03	1.00		3.00												0.06	2.00		6.00				0.03	1.00		0.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.03	1.00		3.00												0.06	2.00		6.00				0.03	1.00		0.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				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	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													26.00	25		25					19.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													65.00	37		37					53.00	35		35												37		37					35		35			37				37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													62.00	42		42					44.00	35		35												42		42					35		35			42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					19.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.20	6.00		18.00					0.06	2.00		6.00												0.20	6.00		18.00				0.06	2.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													61.00	37		37					53.00	35		35												37		37					35		35			37				37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	25		25					19.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				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	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.03	1.00		3.00												0.06	2.00		6.00				0.03	1.00		0.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.06	2.00		6.00												0.16	5.00		15.00				0.06	2.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													71.00	47		47					43.00	35		35												47		47					35		35			47				47	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	25		25					19.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													67.00	41		41					49.00	35		35												41		41					35		35			41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.03	1.00		3.00												0.06	2.00		6.00				0.03	1.00		0.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.30	9.00		27.00					0.06	2.00		6.00												0.30	9.00		27.00				0.06	2.00		0.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					17.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													67.00	45		45					44.00	35		35												45		45					35		35			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													66.00	40		40					51.00	35		35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.03	1.00		3.00												0.06	2.00		6.00				0.03	1.00		0.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.20	6.00		18.00					0.06	2.00		6.00												0.20	6.00		18.00				0.06	2.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													62.00	42		42					44.00	35		35												42		42					35		35			42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.20	6.00		18.00					0.06	2.00		6.00												0.20	6.00		18.00				0.06	2.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													65.00	43		43					47.00	35		35												43		43					35		35			43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	25		25					19.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													66.00	42		42					47.00	35		35												42		42					35		35			42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													70.00	47		47					44.00	35		35												47		47					35		35			47				47	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.23	7.00		21.00					0.06	2.00		6.00												0.23	7.00		21.00				0.06	2.00		0.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													67.00	43		43					43.00	35		35												43		43					35		35			43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.06	2.00		6.00												0.16	5.00		15.00				0.06	2.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													26.00	25		25					19.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													75.00	46		46					47.00	35		35												46		46					35		35			46				46	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.06	2.00		6.00												0.16	5.00		15.00				0.06	2.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													54.00	40		40					43.00	35		35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				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	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													61.00	40		40					48.00	35		35												40		40					35		35			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.06	2.00		6.00												0.16	5.00		15.00				0.06	2.00		0.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					18.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								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	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													63.00	45		45					45.00	35		35												45		45					35		35			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					0.06	2.00		6.00												0.13	4.00		12.00				0.06	2.00		0.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					17.00	20		20												25		25					20		17			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.03	1.00		3.00												0.10	3.00		9.00				0.03	1.00		0.00				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	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													67.00	44		44					47.00	35		35												44		44					35		35			44				44	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	1	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.20	6.00		18.00					0.06	2.00		6.00												0.20	6.00		18.00				0.06	2.00		0.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													26.00	25		25					20.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													73.00	50		50					41.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													67.00	50		50					38.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					18.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					17.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													62.00	50		50					38.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					17.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													63.00	50		50					34.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					18.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													61.00	50		50					35.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													61.00	50		50					32.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					18.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													64.00	50		50					34.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					16.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													56.00	50		50					28.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					17.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	25		25					16.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													64.00	50		50					35.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													53.00	50		50					29.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	25		25					16.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													21.00	25		25					15.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													59.00	50		50					31.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	25		25					16.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													63.00	50		50					33.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					16.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													71.00	50		50					34.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													59.00	50		50					30.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					17.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													66.00	50		50					38.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					17.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													66.00	50		50					34.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	25		25					19.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													64.00	50		50					35.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					18.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													60.00	50		50					32.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					17.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	25		25					17.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													60.00	50		50					32.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													53.00	50		50					31.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	25		25					16.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					17.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													64.00	50		50					34.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	25		25					17.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													55.00	50		50					31.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													59.00	50		50					35.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					18.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													67.00	50		50					41.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	25		25					19.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					18.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													70.00	50		50					39.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													67.00	50		50					40.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	25		25					17.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	25		25					16.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													60.00	50		50					35.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													21.00	25		25					16.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													60.00	50		50					30.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													63.00	50		50					37.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													21.00	25		25					16.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	25		25					17.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													62.00	50		50					35.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								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	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	25		25					16.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													57.00	50		50					35.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													29.00	25		25					22.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													59.00	50		50					37.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2	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					0.03	1.00		3.00												0.33	10.00		30.00				0.03	1.00		0.00				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	2	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.10	33.00		99.00					0.13	4.00		12.00												1.10	33.00		99.00				0.13	4.00		0.00				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	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													76.00	50		50					46.00	35		35												50		50					35		35			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													24.00	25		25					19.00	20		20												25		25					20		20			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	3	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					.90	28.00		84.00					.90	28.00		84.00																		33.00				.90	28.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.32	10.00		30.00					.16	5.00		15.00					.16	5.00		15.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	3	5	Specialty Tier	1	3	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													517.26	31		31					517.26	31		31					31		31																	31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	3	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					2.90	90.00		270.00					2.90	90.00		270.00																		95.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_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					1.29	40.00		120.00					1.29	40.00		120.00																		45.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	3	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.25	8.00		24.00					.09	3.00		9.00					.09	3.00		9.00																		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	3	2	Non-Preferred Generic	3	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.48	15.00		45.00					.32	10.00		30.00					.32	10.00		30.00																		15.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5904	002	0		29	10	S5904_002_0	3	5	Specialty Tier	1	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													662.63	33		33					662.63	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	3	4	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					2.90	90.00		270.00					2.90	90.00		270.00																		95.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_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					1.29	40.00		120.00					1.29	40.00		120.00																		45.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	3	5	Specialty Tier	3	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													662.63	33		33					662.63	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	3	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.25	8.00		24.00					.09	3.00		9.00					.09	3.00		9.00																		8.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	3	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					.32	10.00		30.00					.32	10.00		30.00																		15.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	5	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					1195.00	29																							29																			29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	5	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	5	3	Preferred Brand	1	3	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												
S5916	001	0		29	10	S5916_001_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.50	15.00		30.00																					0.50	15.00		30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	5	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		20.00																					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	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1360.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		237.50																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	002	0		29	10	S5916_002_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		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												
S5916	002	0		29	10	S5916_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.40	12.00		24.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		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										1		
S5916	002	0		29	10	S5916_002_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		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												
S5921	348	0		29	10	S5921_348_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					.66	20.00		60.00															105.00							45.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.33	40.00		120.00															150.00							105.00				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	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													436.00	25		25					436.00	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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					.66	20.00		60.00															120.00							45.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.16	35.00		105.00															165.00							90.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													438.00	25		25					438.00	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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.03	1.00		3.00															9.00							0.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							2.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					.66	20.00		60.00															135.00							45.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.00	60.00		180.00					1.16	35.00		105.00															180.00							90.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													428.00	25		25					428.00	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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					.66	20.00		60.00															105.00							45.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.16	35.00		105.00															150.00							90.00				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	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													416.00	25		25					416.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													425.00	25		25					425.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.16	35.00		105.00															150.00							90.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							2.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.03	1.00		3.00															9.00							0.00				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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					.66	20.00		60.00															120.00							45.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													425.00	25		25					425.00	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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.16	35.00		105.00															165.00							90.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.66	20.00		60.00															90.00							45.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							2.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													459.00	25		25					459.00	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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.33	40.00		120.00															150.00							105.00				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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.66	20.00		60.00															90.00							45.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							2.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													406.00	25		25					406.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	1	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					1.16	35.00		105.00															120.00							90.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					.66	20.00		60.00															105.00							45.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.06	2.00		6.00															9.00							2.00				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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.83	25.00		75.00															90.00							60.00				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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.50	45.00		135.00															165.00							120.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													410.00	25		25					410.00	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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.03	1.00		3.00															9.00							0.00				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	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													479.00	25		25					479.00	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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.16	35.00		105.00															150.00							90.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.66	20.00		60.00															90.00							45.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													514.00	25		25					514.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.16	35.00		105.00															150.00							90.00				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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					.66	20.00		60.00															105.00							45.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.06	2.00		6.00															9.00							2.00				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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.83	25.00		75.00															90.00							60.00				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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.50	45.00		135.00															150.00							120.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													430.00	25		25					430.00	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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													500.00	25		25					500.00	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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.33	40.00		120.00															150.00							105.00				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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.83	25.00		75.00															90.00							60.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					.83	25.00		75.00															105.00							60.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													474.00	25		25					474.00	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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.50	45.00		135.00															165.00							120.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							2.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.03	1.00		3.00															9.00							0.00				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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.00	30.00		90.00															105.00							75.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.00	60.00		180.00					1.50	45.00		135.00															180.00							120.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													450.00	25		25					450.00	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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.33	40.00		120.00															150.00							105.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													452.00	25		25					452.00	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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					.83	25.00		75.00															105.00							60.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.03	1.00		3.00															9.00							0.00				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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													508.00	25		25					508.00	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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.33	40.00		120.00															165.00							105.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.83	25.00		75.00															90.00							60.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.06	2.00		6.00															9.00							2.00				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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													532.00	25		25					532.00	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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.66	20.00		60.00															90.00							45.00				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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.00	60.00		180.00					1.33	40.00		120.00															180.00							105.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													483.00	25		25					483.00	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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.33	40.00		120.00															165.00							105.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.66	20.00		60.00															90.00							45.00				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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.03	1.00		3.00															9.00							0.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							2.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.03	1.00		3.00															9.00							0.00				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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.50	45.00		135.00															150.00							120.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					.83	25.00		75.00															105.00							60.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													456.00	25		25					456.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													492.00	25		25					492.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.33	40.00		120.00															165.00							105.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.66	20.00		60.00															90.00							45.00				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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.50	45.00		135.00															150.00							120.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.83	25.00		75.00															90.00							60.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.06	2.00		6.00															18.00							2.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													516.00	25		25					516.00	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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.03	1.00		3.00															9.00							0.00				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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.03	1.00		3.00															9.00							0.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							2.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.66	20.00		60.00															90.00							45.00				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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.33	40.00		120.00															150.00							105.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													443.00	25		25					443.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.06	2.00		6.00															9.00							2.00				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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.83	25.00		75.00															90.00							60.00				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	1	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					1.33	40.00		120.00															120.00							105.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													465.00	25		25					465.00	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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.03	1.00		3.00															9.00							0.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							2.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					.66	20.00		60.00															105.00							45.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.33	40.00		120.00															165.00							105.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													428.00	25		25					428.00	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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													458.00	25		25					458.00	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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.33	40.00		120.00															165.00							105.00				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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.83	25.00		75.00															90.00							60.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.66	20.00		60.00															90.00							45.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.33	40.00		120.00															165.00							105.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													473.00	25		25					473.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.83	25.00		75.00															90.00							60.00				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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.33	40.00		120.00															150.00							105.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													452.00	25		25					452.00	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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.83	25.00		75.00															90.00							60.00				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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.33	40.00		120.00															165.00							105.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													441.00	25		25					441.00	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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.03	1.00		3.00															9.00							0.00				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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.66	20.00		60.00															90.00							45.00				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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					1.33	40.00		120.00															150.00							105.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							2.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													486.00	25		25					486.00	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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.06	2.00		6.00															15.00							2.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													436.00	25		25					436.00	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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.16	35.00		105.00															165.00							90.00				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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.66	20.00		60.00															90.00							45.00				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	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.03	1.00		3.00															9.00							0.00				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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.66	20.00		60.00															90.00							45.00				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	1	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					1.16	35.00		105.00															135.00							90.00				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	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													425.00	25		25					425.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.03	1.00		3.00															9.00							0.00				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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.33	40.00		120.00															165.00							105.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													449.00	25		25					449.00	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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					.83	25.00		75.00															105.00							60.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.06	2.00		6.00															12.00							2.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	1	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.03	1.00		3.00															6.00							0.00				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	1	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					.66	20.00		60.00															90.00							45.00				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	1	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					1.33	40.00		120.00															165.00							105.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	1	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													426.00	25		25					426.00	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	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				.10	3.00	6.00	6.00				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	4	5	Specialty Tier	1	3	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		31						25	25	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	4	4	Non-Preferred Brand	1	3	110000	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				3.16	95.00	190.00	237.50				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	4	3	Preferred Brand	1	3	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				1.46	44.00	88.00	110.00				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	4	2	Non-Preferred Generic	1	3	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				.36	11.00	22.00	27.50				11.00				.35	11.00		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		111	1	30	60	90				1				30	60	90	30		31	.00	.00	.00	.00																												.00	.00	.00	.00				.00	.00	.00	.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		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												
S5953	002	0		29	10	S5953_002_0	5	4	Non-Preferred Brand	1	4	110000	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				3.16	95.00	190.00	237.50				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		111	1	30	60	90				1				30	60	90	30		31	1.00	30.00	60.00	90.00																												1.00	30.00	60.00	90.00				1.00	30.00	60.00	75.00				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		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				.23	7.00	14.00	17.50				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		111	1	30	60	90				1				30	60	90	30		31	0.23	7.00	14.00	21.00																												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		
S5953	002	0		29	10	S5953_002_0	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	.00	.00	.00	.00																												.00	.00	.00	.00				.00	.00	.00	.00				.00				.00	.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	138	0		29	10	S5967_138_0	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.90	27.00		81.00					.06	2.00		6.00												.90	27.00		81.00				.06	2.00		5.00				27.00				.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	138	0		29	10	S5967_138_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	138	0		29	10	S5967_138_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	139	0		29	10	S5967_139_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	139	0		29	10	S5967_139_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.26	8.00		24.00												.96	29.00		87.00				.26	8.00		20.00				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	140	0		29	10	S5967_140_0	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	140	0		29	10	S5967_140_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	141	0		29	10	S5967_141_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.40	12.00		36.00												.96	29.00		87.00				.40	12.00		30.00				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	141	0		29	10	S5967_141_0	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.20	6.00		18.00												.96	29.00		87.00				.20	6.00		15.00				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	143	0		29	10	S5967_143_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.33	10.00		30.00												.96	29.00		87.00				.33	10.00		25.00				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	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.26	38.00		114.00												1.50	45.00		135.00				1.26	38.00		95.00				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	144	0		29	10	S5967_144_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	144	0		29	10	S5967_144_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.46	14.00		42.00												.96	29.00		87.00				.46	14.00		35.00				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	144	0		29	10	S5967_144_0	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	145	0		29	10	S5967_145_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.30	9.00		27.00												.96	29.00		87.00				.30	9.00		22.50				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	146	0		29	10	S5967_146_0	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.40	12.00		36.00												.96	29.00		87.00				.40	12.00		30.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	146	0		29	10	S5967_146_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	146	0		29	10	S5967_146_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	147	0		29	10	S5967_147_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	147	0		29	10	S5967_147_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.20	6.00		18.00												.96	29.00		87.00				.20	6.00		15.00				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	148	0		29	10	S5967_148_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	148	0		29	10	S5967_148_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.33	10.00		30.00												.96	29.00		87.00				.33	10.00		25.00				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	148	0		29	10	S5967_148_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	149	0		29	10	S5967_149_0	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.23	37.00		111.00												1.50	45.00		135.00				1.23	37.00		92.50				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	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.26	8.00		24.00												.96	29.00		87.00				.26	8.00		20.00				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	149	0		29	10	S5967_149_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	150	0		29	10	S5967_150_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	150	0		29	10	S5967_150_0	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	151	0		29	10	S5967_151_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	151	0		29	10	S5967_151_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.30	9.00		27.00												.96	29.00		87.00				.30	9.00		22.50				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	152	0		29	10	S5967_152_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	152	0		29	10	S5967_152_0	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	152	0		29	10	S5967_152_0	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	154	0		29	10	S5967_154_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.43	13.00		39.00												.96	29.00		87.00				.43	13.00		32.50				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.26	38.00		114.00												1.50	45.00		135.00				1.26	38.00		95.00				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	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	155	0		29	10	S5967_155_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	155	0		29	10	S5967_155_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.40	12.00		36.00												.96	29.00		87.00				.40	12.00		30.00				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	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.20	36.00		108.00												1.50	45.00		135.00				1.20	36.00		90.00				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	156	0		29	10	S5967_156_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	156	0		29	10	S5967_156_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.30	9.00		27.00												.96	29.00		87.00				.30	9.00		22.50				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	157	0		29	10	S5967_157_0	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.23	37.00		111.00												1.50	45.00		135.00				1.23	37.00		92.50				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	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.33	10.00		30.00												.96	29.00		87.00				.33	10.00		25.00				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	157	0		29	10	S5967_157_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	158	0		29	10	S5967_158_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	158	0		29	10	S5967_158_0	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.30	9.00		27.00												.96	29.00		87.00				.30	9.00		22.50				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	158	0		29	10	S5967_158_0	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.30	9.00		27.00												.96	29.00		87.00				.30	9.00		22.50				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	159	0		29	10	S5967_159_0	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.26	38.00		114.00												1.50	45.00		135.00				1.26	38.00		95.00				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	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	159	0		29	10	S5967_159_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	160	0		29	10	S5967_160_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	160	0		29	10	S5967_160_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.26	8.00		24.00												.96	29.00		87.00				.26	8.00		20.00				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.23	37.00		111.00												1.50	45.00		135.00				1.23	37.00		92.50				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	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	161	0		29	10	S5967_161_0	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.26	38.00		114.00												1.50	45.00		135.00				1.26	38.00		95.00				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	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.30	9.00		27.00												.96	29.00		87.00				.30	9.00		22.50				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	161	0		29	10	S5967_161_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	162	0		29	10	S5967_162_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	162	0		29	10	S5967_162_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.33	10.00		30.00												.96	29.00		87.00				.33	10.00		25.00				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.20	36.00		108.00												1.50	45.00		135.00				1.20	36.00		90.00				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	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	163	0		29	10	S5967_163_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	163	0		29	10	S5967_163_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.36	11.00		33.00												.96	29.00		87.00				.36	11.00		27.50				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	164	0		29	10	S5967_164_0	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	164	0		29	10	S5967_164_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	165	0		29	10	S5967_165_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.50	15.00		45.00												.96	29.00		87.00				.50	15.00		37.50				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	165	0		29	10	S5967_165_0	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.26	38.00		114.00												1.50	45.00		135.00				1.26	38.00		95.00				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	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	166	0		29	10	S5967_166_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	166	0		29	10	S5967_166_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.33	10.00		30.00												.96	29.00		87.00				.33	10.00		25.00				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	167	0		29	10	S5967_167_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.10	3.00		9.00												.96	29.00		87.00				.10	3.00		7.50				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	167	0		29	10	S5967_167_0	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	167	0		29	10	S5967_167_0	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	168	0		29	10	S5967_168_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.13	4.00		12.00												.96	29.00		87.00				.13	4.00		10.00				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	169	0		29	10	S5967_169_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	169	0		29	10	S5967_169_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.26	8.00		24.00												.96	29.00		87.00				.26	8.00		20.00				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	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		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.66	20.00		60.00												.96	29.00		87.00				.66	20.00		50.00				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	4	Non-Preferred Brand	1	3	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.16	95.00		285.00												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												
S5967	170	0		29	10	S5967_170_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.50	45.00		135.00												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												
S5967	170	0		29	10	S5967_170_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	171	0		29	10	S5967_171_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		31														25								25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	171	0		29	10	S5967_171_0	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		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	3	Preferred Brand	1	3	010001	1	2		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	171	0		29	10	S5967_171_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.26	8.00		24.00												.96	29.00		87.00				.26	8.00		20.00				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		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.90	27.00		81.00					.06	2.00		6.00												.90	27.00		81.00				.06	2.00		5.00				27.00				.87	27.00		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				30							30			30		31														33								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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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				30							30			30		31														33								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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.33	10.00		30.00												.96	29.00		87.00				.33	10.00		25.00				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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				30							30			30		31														33								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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.20	6.00		18.00												.96	29.00		87.00				.20	6.00		15.00				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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				30							30			30		31														33								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		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					0.26	8.00		24.00												.96	29.00		87.00				0.26	8.00		20.00				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	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					1.26	38.00		114.00												1.50	45.00		135.00				1.26	38.00		95.00				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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	5	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	179	0		29	10	S5967_179_0	5	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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	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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	179	0		29	10	S5967_179_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	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		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.26	8.00		24.00												.96	29.00		87.00				.26	8.00		20.00				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	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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	5	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	181	0		29	10	S5967_181_0	5	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.26	8.00		24.00												.96	29.00		87.00				.26	8.00		20.00				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	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.20	6.00		18.00												.96	29.00		87.00				.20	6.00		15.00				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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					0.26	8.00		24.00												.96	29.00		87.00				0.26	8.00		20.00				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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				30							30			30		31														33								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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				95.00				3.06	95.00		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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.23	37.00		111.00												1.50	45.00		135.00				1.23	37.00		92.50				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.26	8.00		24.00												.96	29.00		87.00				.26	8.00		20.00				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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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	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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				95.00				3.06	95.00		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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.26	38.00		114.00												1.50	45.00		135.00				1.26	38.00		95.00				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	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.33	10.00		30.00												.96	29.00		87.00				.33	10.00		25.00				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	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		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.30	9.00		27.00												.96	29.00		87.00				0.30	9.00		22.50				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	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					1.20	36.00		108.00												1.50	45.00		135.00				1.20	36.00		90.00				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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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				30							30			30		31														33								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	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	5	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.16	5.00		15.00												.96	29.00		87.00				.16	5.00		12.50				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	5	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	190	0		29	10	S5967_190_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					0.26	8.00		24.00												.96	29.00		87.00				0.26	8.00		20.00				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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.23	37.00		111.00												1.50	45.00		135.00				1.23	37.00		92.50				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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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				30							30			30		31														33								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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.26	8.00		24.00												.96	29.00		87.00				.26	8.00		20.00				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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				30							30			30		31														33								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	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.26	8.00		24.00												.96	29.00		87.00				.26	8.00		20.00				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.26	38.00		114.00												1.50	45.00		135.00				1.26	38.00		95.00				45.00				1.45	45.00		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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.23	37.00		111.00												1.50	45.00		135.00				1.23	37.00		92.50				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				30							30			30		31														33								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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.26	8.00		24.00												.96	29.00		87.00				.26	8.00		20.00				29.00				.93	29.00		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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.26	38.00		114.00												1.50	45.00		135.00				1.26	38.00		95.00				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				30							30			30		31														33								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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					0.26	8.00		24.00												.96	29.00		87.00				0.26	8.00		20.00				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	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					1.20	36.00		108.00												1.50	45.00		135.00				1.20	36.00		90.00				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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				45.00				1.45	45.00		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		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.30	9.00		27.00												.96	29.00		87.00				.30	9.00		22.50				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				30							30			30		31														33								33														33							33					33				33	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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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				30							30			30		31														33								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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.36	11.00		33.00												.96	29.00		87.00				.36	11.00		27.50				29.00				.93	29.00		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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.26	38.00		114.00												1.50	45.00		135.00				1.26	38.00		95.00				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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					0.26	8.00		24.00												.96	29.00		87.00				0.26	8.00		20.00				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	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					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				45.00				1.45	45.00		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		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.10	3.00		9.00												.96	29.00		87.00				.10	3.00		7.50				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		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				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	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				45.00				1.45	45.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.13	4.00		12.00												.96	29.00		87.00				.13	4.00		10.00				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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				30							30			30		31														33								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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.00	90.00		270.00												3.16	95.00		285.00				3.00	90.00		225.00				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	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					1.33	40.00		120.00												1.50	45.00		135.00				1.33	40.00		100.00				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	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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				30							30			30		31														33								33														33							33					33				33	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		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					0.46	14.00		42.00												.96	29.00		87.00				0.46	14.00		35.00				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	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		135.00												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												
S5967	204	0		29	10	S5967_204_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					3.16	95.00		285.00												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												
S5967	204	0		29	10	S5967_204_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								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		110	01		110	1				30		90	1				30		90	30		31									.30	9.00		27.00					0.00	0.00		0.00												.30	9.00		27.00				0.00	0.00		0.00				9.00				.29	9.00		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		110	01		110	1				30		90	1				30		90	30		31									.96	29.00		87.00					.23	7.00		21.00												.96	29.00		87.00				.23	7.00		17.50				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	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.16	95.00		285.00					2.96	89.00		267.00												3.16	95.00		285.00				2.96	89.00		222.50				95.00				3.06	95.00		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		110	01		110	1				30		90	1				30		90	30		31									1.50	45.00		135.00					1.30	39.00		117.00												1.50	45.00		135.00				1.30	39.00		97.50				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				30							30			30		31														33								33														33							33					33				33	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									.09	3.00		9.00					0.00	0.00		0.00															8.00							3.00				3.00				.09	3.00		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									.32	10.00		30.00					.12	4.00		12.00															17.00							12.00				10.00				.32	10.00		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													43.44	25		25					39.93	23		23														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													90.08	50		50					86.72	48		48														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				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.25	8.00		20.00					.03	1.00		3.00															5.00							0.00				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	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.51	16.00		40.00					.16	5.00		13.00															15.00							10.00				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	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.45	45.00		135.00					1.29	40.00		120.00															105.00							100.00				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	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	2						90	31		31													72.80	50		50					70.46	48		48														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														31								31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00					0.00	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	4	5	Specialty Tier	1	2	010010	1	1		010	01			1				30										30		31														25								25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4	4	Non-Preferred Brand	1	2	110000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.73	82.00	164.00	246.00					2.40	72.00	144.00	216.00					2.40	72.00	144.00	216.00																		72.00				2.32	72.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.36	41.00	82.00	123.00					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												
S5993	001	0		29	10	S5993_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									0.36	11.00	22.00	33.00					0.20	6.00	12.00	18.00					0.10	3.00	6.00	9.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	3	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	3	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31						33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	3	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	3	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	3	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																					0.16	5.00	10.00	15.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.33	10.00	20.00	30.00																					.16	5.00	10.00	15.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5993	003	0		29	10	S5993_003_0	3	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	5	Specialty Tier	1	2	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31													105.32	25	25	25					101.27	25	25	25												25	25	25					25	25	25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	4	4	Non-Preferred Brand	1	2	110000	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31													44.76	40	40	40					44.14	40	40	40												40	40	40					40	40	40			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	4	3	Preferred Brand	1	2	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31									1.00	30.00	60.00	90.00					.66	20.00	40.00	60.00												1.00	30.00	60.00	90.00				.66	20.00	40.00	60.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_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									.20	6.00	12.00	18.00					.10	3.00	6.00	9.00												.20	6.00	12.00	18.00				.10	3.00	6.00	9.00				6.00				.19	6.00		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				30	60	90	1				30	60	90	30		31									.06	2.00	4.00	6.00					0.00	0.00	0.00	0.00												.06	2.00	4.00	6.00				0.00	0.00	0.00	0.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	5	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31													248.29	33	33	33					238.74	33	33	33												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31													68.02	50	50	50					66.04	50	50	50												50	50	50					50	50	50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_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					1.33	40.00	80.00	120.00												1.50	45.00	90.00	112.50				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												
S6506	002	0		29	10	S6506_002_0	5	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	45.00					.33	10.00	20.00	30.00												.50	15.00	30.00	37.50				.33	10.00	20.00	25.00				15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31									.26	8.00	16.00	24.00					.06	2.00	4.00	6.00												.26	8.00	16.00	20.00				.06	2.00	4.00	5.00				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	4	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	31		90				2			90				31		31	.35	11.00		33.00																								27.50																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	001	0		29	10	S7230_001_0	4	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	4	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	4	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	4	5	Specialty Tier	1	2	010010	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	4	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	31		90				2			90				31		31	.35	11.00		33.00																								27.50																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	002	0		29	10	S7230_002_0	4	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	4	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	002	0		29	10	S7230_002_0	4	5	Specialty Tier	1	2	010010	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	4	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	4	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	4	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	31		90				2			90				31		31	.32	10.00		30.00																								25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	003	0		29	10	S7230_003_0	4	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	4	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	003	0		29	10	S7230_003_0	4	5	Specialty Tier	1	2	010010	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	4	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												
S7610	001	0		29	10	S7610_001_0	4	5	Specialty Tier	1	2	010010	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	4	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												
S7610	001	0		29	10	S7610_001_0	4	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												
S7610	001	0		29	10	S7610_001_0	4	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	31		90				2			90				31		31	.35	11.00		33.00																								27.50																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													67.49	25		25					40.50	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1355.10	25							1355.10	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													60.26	42		42					53.09	37		37												42		42					37		37			42				42	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	5	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													68.30	25		25					40.98	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	5	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													75.89	42		42					66.86	37		37												42		42					37		37			42				42	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	5	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1104.74	25							1104.74	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													92.19	40		40					80.67	35		35												40		40					35		35			40				40	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													68.24	25		25					40.94	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													787.57	25							787.57	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													84.58	42		42					74.51	37		37												42		42					37		37			42				42	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													67.91	25		25					40.75	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													897.87	25							897.87	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													68.74	35		35					58.92	30		30												35		35					30		30			35				35	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													65.48	25		25					39.29	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													503.19	25							503.19	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													70.10	42		42					61.76	37		37												42		42					37		37			42				42	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													64.31	25		25					38.58	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													941.29	25							941.29	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													66.53	42		42					58.61	37		37												42		42					37		37			42				42	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													66.06	25		25					39.64	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													837.85	25							837.85	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													68.39	25		25					41.03	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													71.48	42		42					62.97	37		37												42		42					37		37			42				42	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													819.95	25							819.95	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													70.92	25		25					42.55	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													87.41	42		42					77.00	37		37												42		42					37		37			42				42	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													869.46	25							869.46	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													77.51	44		44					68.70	39		39												44		44					39		39			44				44	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													69.40	25		25					41.64	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													805.86	25							805.86	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	5	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													77.70	43		43					68.66	38		38												43		43					38		38			43				43	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	5	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													76.88	25		25					46.13	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	5	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													792.98	25							792.98	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													66.23	25		25					39.74	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													59.05	41		41					51.85	36		36												41		41					36		36			41				41	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													892.93	25							892.93	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													52.96	32		32					44.69	27		27												32		32					27		27			32				32	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													62.30	25		25					37.38	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1021.26	25							1021.26	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													62.58	25		25					37.55	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													63.94	39		39					55.74	34		34												39		39					34		34			39				39	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													920.84	25							920.84	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1085.98	25							1085.98	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													61.21	36		36					52.71	31		31												36		36					31		31			36				36	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													67.43	25		25					40.46	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													65.70	25		25					39.42	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													70.41	42		42					62.03	37		37												42		42					37		37			42				42	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													810.18	25							810.18	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													79.39	25		25					47.63	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													86.73	42		42					76.41	37		37												42		42					37		37			42				42	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													989.65	25							989.65	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													66.16	25		25					39.70	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													66.83	44		44					59.23	39		39												44		44					39		39			44				44	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													962.43	25							962.43	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													909.39	25							909.39	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													64.77	40		40					56.68	35		35												40		40					35		35			40				40	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													61.73	25		25					37.04	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													64.12	41		41					56.30	36		36												41		41					36		36			41				41	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													714.34	25							714.34	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													67.06	25		25					40.24	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													839.25	25							839.25	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	4	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													77.90	42		42					68.63	37		37												42		42					37		37			42				42	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	4	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													68.56	25		25					41.14	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1085.71	25							1085.71	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													48.28	30		30					40.23	25		25												30		30					25		25			30				30	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													69.78	25		25					41.87	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													746.76	25							746.76	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													52.30	31		31					43.86	26		26												31		31					26		26			31				31	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													59.94	25		25					35.97	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1051.60	25							1051.60	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													64.36	36		36					55.42	31		31												36		36					31		31			36				36	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													61.12	25		25					36.67	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													68.15	25		25					40.89	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													75.81	43		43					67.00	38		38												43		43					38		38			43				43	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1244.74	25							1244.74	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													50.95	33		33					43.23	28		28												33		33					28		28			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													59.72	25		25					35.83	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1155.99	25							1155.99	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													70.86	25		25					42.51	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													73.57	43		43					65.02	38		38												43		43					38		38			43				43	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1013.05	25							1013.05	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	4	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													78.37	25		25					47.02	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1133.81	25							1133.81	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	4	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													81.31	45		45					72.28	40		40												45		45					40		40			45				45	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													67.91	39		39					59.20	34		34												39		39					34		34			39				39	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													64.62	25		25					38.77	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													985.88	25							985.88	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													70.26	25		25					42.15	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													62.23	40		40					54.46	35		35												40		40					35		35			40				40	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													953.12	25							953.12	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	4	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													89.57	45		45					79.61	40		40												45		45					40		40			45				45	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	4	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													65.02	25		25					39.01	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													769.22	25							769.22	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													86.31	43		43					76.27	38		38												43		43					38		38			43				43	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													78.65	25		25					47.19	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													589.82	25							589.82	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.20	10.00		30.00					.07	2.00		6.00												.20	10.00		10.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	4	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													61.13	25		25					36.68	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	4	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													63.11	45		45					56.10	40		40												45		45					40		40			45				45	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													876.48	25							876.48	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	3	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	3	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													66.22	25		25					39.73	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	3	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													65.67	42		42					57.86	37		37												42		42					37		37			42				42	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	3	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													987.89	25							987.89	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	1	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													589.82	25							589.82	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	1	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													78.65	25		25					47.19	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	1	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													86.31	43		43					76.27	38		38												43		43					38		38			43				43	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					.07	2.00		6.00												.33	10.00		30.00				.07	2.00		6.00				10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	2	2	Preferred Brand	1	2	010001	1	1		110	01		110	1				30		90	2				30		90	30		31													78.65	25		25					47.19	15		15												25		25					15		15			25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	2	3	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													86.31	43		43					76.27	38		38												43		43					38		38			43				43	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	2	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													589.82	25							589.82	25														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	107	0		29	10	S7694_107_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.67	20.00		60.00					.27	8.00		24.00												.67	20.00		60.00				.27	8.00		24.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	107	0		29	10	S7694_107_0	1	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					1.17	35.00		105.00												1.50	45.00		135.00				1.17	35.00		105.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	107	0		29	10	S7694_107_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.17	95.00		285.00					2.83	85.00		255.00												3.17	95.00		285.00				2.83	85.00		255.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	107	0		29	10	S7694_107_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	107	0		29	10	S7694_107_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					.10	3.00		9.00												.33	10.00		30.00				.10	3.00		9.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	111	0		29	10	S7694_111_0	1	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					1.17	35.00		105.00												1.50	45.00		135.00				1.17	35.00		105.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	111	0		29	10	S7694_111_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.17	95.00		285.00					2.83	85.00		255.00												3.17	95.00		285.00				2.83	85.00		255.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	111	0		29	10	S7694_111_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	111	0		29	10	S7694_111_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.67	20.00		60.00					.27	8.00		24.00												.67	20.00		60.00				.27	8.00		24.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	111	0		29	10	S7694_111_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					.10	3.00		9.00												.33	10.00		30.00				.10	3.00		9.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	112	0		29	10	S7694_112_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	112	0		29	10	S7694_112_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					.10	3.00		9.00												.33	10.00		30.00				.10	3.00		9.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	112	0		29	10	S7694_112_0	1	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					1.17	35.00		105.00												1.50	45.00		135.00				1.17	35.00		105.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	112	0		29	10	S7694_112_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.67	20.00		60.00					.27	8.00		24.00												.67	20.00		60.00				.27	8.00		24.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	112	0		29	10	S7694_112_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.17	95.00		285.00					2.83	85.00		255.00												3.17	95.00		285.00				2.83	85.00		255.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	113	0		29	10	S7694_113_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	113	0		29	10	S7694_113_0	1	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					1.17	35.00		105.00												1.50	45.00		135.00				1.17	35.00		105.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	113	0		29	10	S7694_113_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.17	95.00		285.00					2.83	85.00		255.00												3.17	95.00		285.00				2.83	85.00		255.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	113	0		29	10	S7694_113_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.67	20.00		60.00					.27	8.00		24.00												.67	20.00		60.00				.27	8.00		24.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	113	0		29	10	S7694_113_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					.10	3.00		9.00												.33	10.00		30.00				.10	3.00		9.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	114	0		29	10	S7694_114_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					.10	3.00		9.00												.33	10.00		30.00				.10	3.00		9.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	114	0		29	10	S7694_114_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.67	20.00		60.00					.27	8.00		24.00												.67	20.00		60.00				.27	8.00		24.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	114	0		29	10	S7694_114_0	1	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					1.17	35.00		105.00												1.50	45.00		135.00				1.17	35.00		105.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	114	0		29	10	S7694_114_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	114	0		29	10	S7694_114_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.17	95.00		285.00					2.83	85.00		255.00												3.17	95.00		285.00				2.83	85.00		255.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	115	0		29	10	S7694_115_0	1	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					1.17	35.00		105.00												1.50	45.00		135.00				1.17	35.00		105.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	115	0		29	10	S7694_115_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									.67	20.00		60.00					.27	8.00		24.00												.67	20.00		60.00				.27	8.00		24.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	115	0		29	10	S7694_115_0	1	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									.33	10.00		30.00					.10	3.00		9.00												.33	10.00		30.00				.10	3.00		9.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	115	0		29	10	S7694_115_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	1				30		90	30		31									3.17	95.00		285.00					2.83	85.00		255.00												3.17	95.00		285.00				2.83	85.00		255.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	115	0		29	10	S7694_115_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.32	10.00		30.00					.13	4.00		12.00					.13	4.00		12.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	4	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					.61	19.00		57.00					.61	19.00		57.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	4	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					1.29	40.00		120.00					1.29	40.00		120.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	4	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					2.87	89.00		267.00					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	001	0		29	10	S8067_001_0	4	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				31				31						31		31													490.00	33							490.00	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									.29	9.00		27.00					.13	4.00		12.00					.13	4.00		12.00																		9.00				.29	9.00		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									.68	21.00		63.00					.48	15.00		45.00					.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	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					1.23	38.00		114.00					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	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.06	95.00		285.00					2.87	89.00		267.00					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	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1066.00	33							1066.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	001	0		29	10	S9579_001_0	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					90.05	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	001	0		29	10	S9579_001_0	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	001	0		29	10	S9579_001_0	1	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	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					471.74	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					93.52	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	002	0		29	10	S9579_002_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					492.05	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	1	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	1	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	002	0		29	10	S9579_002_0	1	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	003	0		29	10	S9579_003_0	1	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	003	0		29	10	S9579_003_0	1	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	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					496.47	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	003	0		29	10	S9579_003_0	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					94.60	49	49	49																							49																	49				49	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	003	0		29	10	S9579_003_0	1	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	004	0		29	10	S9579_004_0	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					93.88	49	49	49																							49																	49				49	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	004	0		29	10	S9579_004_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					488.18	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	1	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	1	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																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	004	0		29	10	S9579_004_0	1	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	1	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	1	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	005	0		29	10	S9579_005_0	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					93.76	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	005	0		29	10	S9579_005_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					483.53	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	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	006	0		29	10	S9579_006_0	1	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	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					462.06	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					87.31	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	006	0		29	10	S9579_006_0	1	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	1	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	007	0		29	10	S9579_007_0	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					88.33	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	007	0		29	10	S9579_007_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					470.24	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	1	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	1	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	007	0		29	10	S9579_007_0	1	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	1	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	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	008	0		29	10	S9579_008_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					485.45	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	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					94.62	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	009	0		29	10	S9579_009_0	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	009	0		29	10	S9579_009_0	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					89.15	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	009	0		29	10	S9579_009_0	1	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	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					466.91	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					94.94	48	48	48																							48																	48				48	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	010	0		29	10	S9579_010_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					528.10	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	1	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	1	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	1	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	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	011	0		29	10	S9579_011_0	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					85.60	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	011	0		29	10	S9579_011_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					446.96	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	011	0		29	10	S9579_011_0	1	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	012	0		29	10	S9579_012_0	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					88.42	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	012	0		29	10	S9579_012_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					466.83	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	1	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	012	0		29	10	S9579_012_0	1	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	012	0		29	10	S9579_012_0	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	013	0		29	10	S9579_013_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					464.99	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					88.30	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	013	0		29	10	S9579_013_0	1	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	013	0		29	10	S9579_013_0	1	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	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					84.92	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	014	0		29	10	S9579_014_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					443.19	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	014	0		29	10	S9579_014_0	1	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	1	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	1	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	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					465.65	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					88.08	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	015	0		29	10	S9579_015_0	1	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	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	015	0		29	10	S9579_015_0	1	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	1	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	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					90.15	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	016	0		29	10	S9579_016_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					476.60	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	1	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	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					461.74	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					87.45	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	017	0		29	10	S9579_017_0	1	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	1	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	017	0		29	10	S9579_017_0	1	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	1	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	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	018	0		29	10	S9579_018_0	1	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	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					460.15	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					87.95	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	019	0		29	10	S9579_019_0	1	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	1	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	019	0		29	10	S9579_019_0	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					87.18	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	019	0		29	10	S9579_019_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					457.48	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	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	020	0		29	10	S9579_020_0	1	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	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					93.15	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	020	0		29	10	S9579_020_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					475.82	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	1	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	021	0		29	10	S9579_021_0	1	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	021	0		29	10	S9579_021_0	1	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	021	0		29	10	S9579_021_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					487.67	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					92.52	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	022	0		29	10	S9579_022_0	1	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	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	022	0		29	10	S9579_022_0	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					90.41	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	022	0		29	10	S9579_022_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					474.95	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	1	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	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					454.71	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					86.32	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	023	0		29	10	S9579_023_0	1	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	1	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	023	0		29	10	S9579_023_0	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					89.13	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	024	0		29	10	S9579_024_0	1	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	024	0		29	10	S9579_024_0	1	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	024	0		29	10	S9579_024_0	1	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	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					475.45	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					89.82	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					469.97	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					94.36	49	49	49																							49																	49				49	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	026	0		29	10	S9579_026_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					502.07	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	1	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	1	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	026	0		29	10	S9579_026_0	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					94.00	49	49	49																							49																	49				49	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	027	0		29	10	S9579_027_0	1	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	1	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																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	027	0		29	10	S9579_027_0	1	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	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					469.15	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	028	0		29	10	S9579_028_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					465.16	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	028	0		29	10	S9579_028_0	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					88.41	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	028	0		29	10	S9579_028_0	1	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	1	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	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	029	0		29	10	S9579_029_0	1	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	1	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																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	029	0		29	10	S9579_029_0	1	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	029	0		29	10	S9579_029_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					485.16	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					93.44	49	49	49																							49																	49				49	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	030	0		29	10	S9579_030_0	1	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	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	030	0		29	10	S9579_030_0	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					94.33	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	030	0		29	10	S9579_030_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					485.74	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					92.35	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	031	0		29	10	S9579_031_0	1	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	1	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	031	0		29	10	S9579_031_0	1	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	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					482.86	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	1	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	1	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	032	0		29	10	S9579_032_0	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					94.38	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	032	0		29	10	S9579_032_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					492.84	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	1	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	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.22	7.00	14.00	21.00																								20.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	033	0		29	10	S9579_033_0	1	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	1	4	Non-Preferred Brand	1	2	100000	1	1	111		01	100		1	31	60	90				1			90				31		31					87.77	50	50	50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	033	0		29	10	S9579_033_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					449.13	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	1	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	034	0		29	10	S9579_034_0	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					594.43	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	035	0		29	10	S9579_035_0	1	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	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					587.94	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	036	0		29	10	S9579_036_0	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					607.55	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	037	0		29	10	S9579_037_0	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					593.82	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	1	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	038	0		29	10	S9579_038_0	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					589.36	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	039	0		29	10	S9579_039_0	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					589.83	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	1	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	040	0		29	10	S9579_040_0	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					587.52	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	041	0		29	10	S9579_041_0	1	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	041	0		29	10	S9579_041_0	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					591.31	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	042	0		29	10	S9579_042_0	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					579.41	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	042	0		29	10	S9579_042_0	1	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	042	0		29	10	S9579_042_0	1	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	043	0		29	10	S9579_043_0	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					666.34	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	1	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	044	0		29	10	S9579_044_0	1	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	044	0		29	10	S9579_044_0	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	044	0		29	10	S9579_044_0	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					560.52	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					576.10	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	1	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	1	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	045	0		29	10	S9579_045_0	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	045	0		29	10	S9579_045_0	1	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	1	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	046	0		29	10	S9579_046_0	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					590.06	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	047	0		29	10	S9579_047_0	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	047	0		29	10	S9579_047_0	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					576.76	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	048	0		29	10	S9579_048_0	1	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	1	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	048	0		29	10	S9579_048_0	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					583.51	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	049	0		29	10	S9579_049_0	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	049	0		29	10	S9579_049_0	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					591.05	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	1	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	050	0		29	10	S9579_050_0	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					587.07	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					573.74	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	051	0		29	10	S9579_051_0	1	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	1	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	052	0		29	10	S9579_052_0	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					584.88	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	1	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	052	0		29	10	S9579_052_0	1	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	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					562.38	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	053	0		29	10	S9579_053_0	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	053	0		29	10	S9579_053_0	1	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	054	0		29	10	S9579_054_0	1	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	054	0		29	10	S9579_054_0	1	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	054	0		29	10	S9579_054_0	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					601.13	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	054	0		29	10	S9579_054_0	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					585.25	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	1	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	055	0		29	10	S9579_055_0	1	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	056	0		29	10	S9579_056_0	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					574.31	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	056	0		29	10	S9579_056_0	1	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	1	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	057	0		29	10	S9579_057_0	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					582.56	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	058	0		29	10	S9579_058_0	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					603.19	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	058	0		29	10	S9579_058_0	1	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	1	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	059	0		29	10	S9579_059_0	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	059	0		29	10	S9579_059_0	1	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	1	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	059	0		29	10	S9579_059_0	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					616.18	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	060	0		29	10	S9579_060_0	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	060	0		29	10	S9579_060_0	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					582.77	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	061	0		29	10	S9579_061_0	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					592.98	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	1	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	062	0		29	10	S9579_062_0	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					580.02	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	063	0		29	10	S9579_063_0	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					582.88	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	064	0		29	10	S9579_064_0	1	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	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					590.95	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	065	0		29	10	S9579_065_0	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					618.12	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	1	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	1	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	1	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.58	18.00	36.00	54.00																								45.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	066	0		29	10	S9579_066_0	1	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	1	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	1	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					582.54	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
